Deep Dive Into Total Arterial Anaortic Off-Pump Coronary Artery Bypass Grafting: Radial Artery to Posterior Descending Artery Anastomosis

Total arterial anaortic off-pump coronary artery bypass surgery is an elegant cardiac procedure. It is important not to rush through the OPCAB surgery. Instead, try to get into the rhythm! In this video series, Professor Yan has demonstrated some reproducible techniques that utilize all arterial grafts (“Total Arterial,” for best long-term performance) and avoid any manipulation of the ascending aorta (“Anaortic,” to minimize stroke risk) to achieve complete surgical revascularization on a beating heart without the use of cardiopulmonary bypass.

Previously, the radial artery “T” graft has been anastomosed in a side-to-side fashion to the obtuse marginal artery. In this video, the heart is elevated cranially, and an octopus evolution tissue stabilizer is used to expose the posterior descending artery (PDA). The distal end of the radial artery is prepared for an end-to-side anastomosis to the PDA. A silastic sling is passed around the proximal PDA and then the artery is opened. A silastic shunt is then placed into the lumen to avoid distal segment ischemia and, at the same time, protect the back wall. A 7-0 Prolene suture is used to perform the end-to-side anastomosis. At the end of the anastomosis, the bulldog is removed from the radial artery and the whole heart is reperfused. 

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