Beating heart surgery

Summary Coronary artery bypass grafting (CABG) is one of the most frequently performed surgical procedures in developed countries. Concerning the increased incidence of coronary artery disease its application is expected to rise. The standard procedure, using cardiopulmonary bypass (CPB) with cardioplegic arrest for complete revascularisation is safe and effective with a low mortality rate in elective patients. However, there is still a substantial morbidity related to CPB and cardioplegic arrest. CPBrelated adverse side effects can induce a systemic inflammatory response caused by the activation of plasma protein systems and generate micro emboli. To avoid these deleterious effects, the technique of operating on a beating heart for CABG (OPCAB) has been introduced. The introduction of cardiac stabilisers and other technical devices have improved the surgical procedure leading to comparable conditions concerning the quality of anastomoses. Therefore this technique is becoming increasingly popular and many reports support the theoretical and practical advantage compared to standard procedures. The advantage of OPCAB procedure also includes the reduction of postoperative morbidity with a shorter hospitalization and lower cost containment. Particularly the benefit of elderly and highrisk patients from OPCAB surgery is encouraging. This review presents the OPCAB-technique we routinely perform in our institution. We also discuss some considerations which should be addressed if this technique is to establish as a part of the surgical treatment in patients with coronary artery disease.