Table 3

Disadavantages and technical limitations of off-pump coronary artery bypass surgery

Technical issuesProposed solutions
Motion of the heartPharmacologic or mechanical stabilisation
Tempory interruption of coronary flowLuminal shunt during construction of anastomosis
Arteriotomy seal
Distal perfusion cannula
Blood flow in arteriotomyTemporary luminal shunt
Saline infusion
Carbon dioxide gas blower
Pressure dropTrendelenburg, inotropic support, fluid
Limited space for:Miniaturisation of instruments
    preparation of mammary arteryEndoscopic video assisted surgery
    identification of coronary artery
    construction of anastomosis