Beating heart coronary surgery and the ‘foundation stone’ evidence

Over the last decade, technical improvements have made off-pump coronary artery bypass (OPCAB) surgery a routine procedure. Exposure and positioning of the three main coronary targets with minimal haemodynamic deterioration has been achieved with a combination of pericardial retraction sutures, the Trendelenburg manoeuvre, and rotation of the operating table.1-3 Intracoronary shunts have been introduced to prevent snaring-related injury of the coronary vessels and to allow myocardial perfusion during the construction of the anastomoses.