Surgical Science of OPCAB

Bachground: OPCAB, though as old as coronary surgery, simplicity, low cost, better outcome and its unique life saving quality in certain cases has not become the universal operation. The reason might be the original presentation which was technical withoutadequate science of its own but base on the background of CABG science. Therefore concern about inadequate revascularization was a reality from the beginning.
Material & Methods: Our efforts which helped to overcome the above concerns led to the discovery that inspection of the beating heart is an accurate way to diagnose possible local ischemia associated with coronary occlusion, positioning and stabilization during OPCAB. Visible changes in color and contractility were tested& proved to be accurate tools in predicting the need for cardio pulmonary bypass before global mal function and severe hemodynamic deterioration occurs.
Results: Practicing such a training protocol resulted in 1: avoidance of “crash conversion”. 2: created a safe and stress free environment and resulted in a overall mortality<1%. In addition accurate observation of the heart has given new insight into the anatomy and physiology of coronary circulations namely corrugated anatomy and capacitances vessel physiology.
Conclusion: Training in visual diagnosis of cardiac changes during OPCAB provides the ability to predict the course of the operation& timely information about the need for cardio pulmonary bypass. The intra operative complication are avoided& presence of safe and stress free environment provides for complete revascularizations. Therefore we recommend this practice to everybody.