非体外循环冠状动脉旁路移植术治疗重症冠状动脉粥样硬化性心脏病

目的探讨非体外循环冠状动脉旁路移植术治疗重症冠状动脉粥样硬化性心脏病(冠心病)的可行性. 方法回顾分析2002年1月～12月37例重症冠心病的临床资料.均采用全麻,胸骨正中切口,游离左乳内动脉及大隐静脉.心脏稳定器局部固定心肌,显露目标冠状动脉,切开后置入冠状动脉内血液分流器.一般先做左乳内动脉与左冠状动脉前降支的吻合,其余血管桥先做桥血管与主动脉的近心端吻合,然后再做桥血管与冠状动脉的吻合. 结果全组病例均在非体外循环下完成手术,搭桥1～6支,(3.2±0.5)支.术后10 d死亡1例,其余36例未发生围术期心肌梗死,无呼吸功能不全、肾功能不全、脑血管意外等严重并发症. 结论在成熟的手术技术和严格的围手术期管理的条件下,非体外循环冠状动脉旁路移植术治疗重症冠心病可行.     

合并升主动脉钙化的冠心病人冠状动脉多支搭桥的策略

目的探讨冠状动脉粥样硬化性心脏病（冠心病）合并升主动脉钙化行冠状动脉多支搭桥的策略。方法2002年6月-2007年12月对36例合并升主动脉钙化的冠心病不使用主动脉侧壁钳行非体外循环冠状动脉搭桥术。常规取左乳内动脉（left internal mammary artery,LIMA）,19例同时取右乳内动脉（right internal mammary,RIMA）。15例以LIMA为唯一的桥血流来源（in-flow）,其余的静脉桥吻合到LIMA;14例使用Enclose或Heartstring近端吻合装置行静脉桥在主动脉上的吻合。术中用血流仪（Medi-Stim Butterfly Flow Meter,Oslo,Norway）行桥血流定量测定。结果36例共行远端吻合116个[2-5个,（3.2±0.9）个]。术后2-22 h病人完全清醒。手术中实时桥血流测定满意,15例以LIMA为唯一in-flow的患者,LIMA主干的总血流量基本是各分支桥血流量的数学和。无围手术期心肌梗死及脑卒中。8例（26.7%）手术后一过性心房颤动;肺部感染2例;胸腔积液4例;下肢切口感染1例,均治愈。死亡1例,死亡原因为多脏器功能衰竭。30例随访6-60个月,（33.8±11.2）月,11例造影显示37支桥中,LIMA-LAD均通畅,2支到对角支的静脉桥闭塞,余静脉桥均通畅。结论对升主动脉有明显钙化的冠心病患者,采用非体外循环冠状动脉搭桥结合主动脉No-touch技术或主动脉近端吻合装置,可有效避免因在病变主动脉上操作引起的术后脑卒中发生。     

非体外循环冠状动脉搭桥术的技术改进──先吻合桥血管近端的“顺行序贯式”吻合术

目的探讨先吻合桥血管近端的“顺行序贳式”吻合技术住非体外循环心脏不停跳冠状动脉旁路移植术（off-pump coronary artery bypass grafting,OPCABG）中应用的临床意义和价值。方法56例患者行OPCABG术中采用先吻合桥血管近端的“顺行序贯式”吻合术：先行带蒂左乳内动脉与左前降支吻合;若使用游离桥血管则先与升主动脉吻合,再与左前降支吻合。然后用大隐静脉或桡动脉进行“序贯式”吻合搭桥。结果与左前降支吻合的桥血管：带蒂左乳内动脉49支,游离左乳内动脉1支,桡动脉4支,大隐静脉2支。采用大隐静脉进行“序贯式”吻合：4个吻合口（包括近端吻合口）32例,3个吻合口15例。桡动脉进行“序贯式”吻合：4个吻合口2例,3个吻合口7冽。大隐静脉-右冠状动脉单桥5支。总搭桥207支,平均3．7支／例。术后心绞痛症状全部缓解,无围术期急性心肌梗塞。54例随访2～70个月,无新发心绞痛,无死亡病例。结论应用先吻合桥血管近端的“顺行序贯式”吻合技术,可使OPCABG更简便、安全、有效,更有益于多支病变患者,尤其是急危重症的冠心病患者。     

升主动脉不接触技术在非体外循环冠状动脉旁路移植术中的应用

目的总结升主动脉不接触技术在非体外循环冠状动脉旁路移植术(off-pump CABG)中的应用经验,以减少术后脑卒中的发生。方法回顾分析31例合并升主动脉粥样硬化冠心病患者的临床资料,男25例,女6例;年龄58～78岁,平均年龄71.3岁。5例联合应用off-pump CABG和经皮腔内冠状动脉成形术(PTCA)杂交技术治疗,其余26例均采用常规胸骨正中切口径路行off-pump CABG。9例双侧乳内动脉原位移植;16例以左乳内动脉为惟一的供血来源,大隐静脉或桡动脉近端与左乳内动脉端侧吻合;1例大隐静脉近端吻合到无名动脉。所有患者主动脉根部均无吻合口。结果5例"杂交"手术患者共经PTCA植入支架6枚,26例胸骨正中开胸患者移植血管74支(2～4支/例),全组患者手术均顺利完成,痊愈出院,无院内死亡。术后心绞痛消失24例,明显缓解7例。发生心房颤动2例,行二次开胸手术1例,肺部感染2例,切口感染1例,无围术期心肌梗死和神经系统并发症发生。随访29例,随访3个月～3年,失访2例。随访期间无死亡,1例行"杂交"手术患者术后1年心绞痛再发,其余28例患者生活质量良好,无神经、精神系统并发症发生。结论对合并升主动脉粥样硬化的冠心病患者,采用off-pump CABG结合升主动脉不接触技术治疗,可有效地减少术后神经系统并发症的发生,临床效果满意。     

Heartstring无阻断近端吻合系统在OPCAB术中的应用

神经系统并发症是冠状动脉旁路移植（冠脉搭桥）术后最常见的并发症之一,多因术中行升主动脉操作造成内膜斑块脱落引发.随着非体外循环下冠状动脉旁路移植术（OPCAB）的广泛开展,因主动脉插管造成的冠脉搭桥术后神经系统并发症的概率明显下降.但大隐静脉仍是绝大多数冠脉搭桥术的主要选材,需要在升主动脉上进行外科钳夹及打孔操作,因此,主动脉斑块脱落仍然是术后神经系统并发症的主要原因之一.近年来,大量的桥血管近端吻合辅助器械应运而生.现将我们对60例行OPCAB病人应用Heartstring主动脉近端吻合器的经验和体会报道如下.     

非体外循环下双侧乳内动脉Y型桥的冠状动脉旁路移植术125例

目的总结非体外循环下采用双侧乳内动脉Y型桥进行完全心肌血运重建的冠状动脉旁路移植手术125例的近期疗效。方法2002年10月至2005年12月,完成125例不停跳非体外循环下双侧乳内动脉Y型桥的冠状动脉旁路移植手术,术中采用带蒂半骨骼化的方法分别取材左、右侧的乳内动脉,将左、右乳内动脉端侧吻合成Y型桥;在非体外循环下,应用序贯吻合的方法进行冠状动脉搭桥手术。结果全组125例患者共搭桥413支,平均搭桥支数3．3支／例。术中流量测定桥血管均通畅。全组患者无围手术期死亡。结论非体外循环下双乳内动脉Y型桥的冠状动脉旁路移植手术是安全、有效的方法,可以实现全动脉化的完全心肌血运重建,又避免手术中对升主动脉的操作,近期效果满意。     

升主动脉隔离装置在升主动脉近端钙化患者非体外循环冠状动脉旁路移植术中的应用

目的 评价升主动脉近端隔离装置(Heartstring和Enclose近端吻合装置)在非体外循环冠状动脉旁路移植术(OPCAB)中的应用效果. 方法 2006年1月至2008年2月收治了150例合并升主动脉近端钙化的冠心病患者,其中男102例,女48例;年龄55～78岁,平均年龄69岁.所有患者在冠状动脉旁路移植术中应用升主动脉近端隔离装置,大隐静脉与升主动脉近端共完成251个吻合口,升主动脉近端吻合口1～3个/例,大隐静脉桥血管完成后应用流量仪进行流量测定.术后观察神经系统并发症的发生情况. 结果 术后死于低心排血量综合征1例(0.67%);二次开胸止血2例,其中1例为乳内动脉床渗血,1例为胸骨后出血;其余患者术后24 h胸腔引流量为100～200 ml.所有患者均于术后24～48 h内顺利拔除气管内插管;术后均未出现明确的昏迷、肢体偏瘫、语言障碍及运动不协调等神经系统并发症;大隐静脉桥血流量为28.5～70.1 L/min(53.7± 23.9 L/min).术后随访145例,随访率97.32%,随访时间3个月～1年;4例失访.随访期间患者未发生迟发性脑出血或脑梗死等神经系统并发症.结论 在OPCAB术中应用Heartstring和Enclose升主动脉近端隔离装置,安全、有效,能有效地降低脑卒中的发生率.     

非体外循环双侧乳内动脉完全心肌血运重建

目的 评估非体外循环双侧乳内动脉完全心肌血运重建治疗的效果。方法 2000年10月至2004年8月，共行双侧乳内动脉“Y”形吻合冠状动脉旁路移植（冠脉搭桥）52例，年龄33～78岁，平均56岁。3支病变者42例（80．8％），左主干病变者10例（19．2％）。心功能分级Ⅱ级46例，Ⅲ级4例。脑CT检查示陈旧性脑梗者11例（21．2％），颈动脉病变者21例（40．4％）。制备双侧乳内动脉，将游离的右侧乳内动脉吻合于左侧乳内动脉成“Y”形。均在心脏不停跳下进行冠脉搭桥，左侧乳内动脉序贯吻合对角支、左前降支，右侧乳内动脉序贯吻合于中间支、回旋支（钝缘支、左室后支）、后降支。并应用Tranortie H1311流量计进行桥血管的流量测定。结果 全组52例共行冠脉搭桥171支，平均3．3支/人。全组病人无死亡。围术期心梗2例，应用IABP 1例，开胸止血1例。全组无脑部并发症，无胸骨纵隔感染。结论 非体外循环下双侧乳内动脉“Y”形冠状动脉搭桥是安全、有效的手术方式，可以实现全动脉化的完全心肌血运重建，手术近期效果满意，远期效果有待进一步的随访观察。     

冠状动脉硬化性心脏病合并左锁骨下动脉严重狭窄非体外循环下同期手术的临床经验

目的探讨非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路治疗冠状动脉硬化性心脏病(冠心病)合并锁骨下动脉重度狭窄的手术方法及效果.方法2003年1月～2004年5月,我院治疗须行冠状动脉旁路移植术同时合并左锁骨下动脉近端重度狭窄3例,术中先行主动脉-锁骨下动脉旁路,左乳内动脉获得满意的流量后,再行非体外循环冠状动脉旁路移植.结果手术时间210～340 min,平均283 min,出血量570～1 630 ml,平均963 ml.游离左乳内动脉后量杯测流量均＜5 ml/min,主动脉-锁骨下动脉旁路后量杯测流量均＞50 ml/min,乳内动脉远端与前降支吻合后流量仪测流量12～27 ml/min,平均20 ml/min.术后临床症状缓解,未发现冠脉-锁骨下动脉窃血综合征.3例随访3～6个月,平均5个月,无心绞痛发作.结论非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路手术是治疗冠心病合并锁骨下动脉重度狭窄简单而有效的方法.     

体外循环下左乳内动脉、桡动脉“T型”吻合行左心全动脉化的临床分析

目的研究体外循环下左乳内动脉、桡动脉"T型"吻合行左心室全动脉化的冠状动脉旁路移植术的临床效果。方法回顾性分析2013年12月至2015年12月我院心外科40例行体外循环下左乳内动脉、桡动脉"T型"吻合行左心室全动脉化的冠状动脉旁路移植术患者的临床资料,男27例、女13例,年龄46~70(55.0±10.2)岁。采用冠状动脉血流测量仪分别测量左乳内动脉原位状态及术后左乳内动脉主干血流量情况,分别检测患者术前及术后24 h血清中血肌钙蛋白I(c Tn I)的浓度,观察患者术后并发症发生情况。结果术后左乳内动脉主干血量明显高于术前左乳内动脉原位状态血量,差异有统计学意义(P0.05)。术后24 h患者血清中血肌钙蛋白I的浓度略高于术前,但差异无统计学意义(P0.05)。全组患者无死亡,术后早期发生快速心房颤动2例,术后低心排血量1例,经治疗后全部好转,无围术期心肌梗塞、无神经系统并发症,桡动脉切口无并发症。随访6个月至1年,无心源性并发症,无心绞痛复发。25例患者术后1年时随访行冠状动脉CTA检查桥血管通畅率,动脉桥通畅率96.0%,右冠状动脉静脉桥血管通畅率为90.4%。结论体外循环下左乳内动脉、桡动脉T型吻合行左心室全动脉化的冠状动脉旁路移植术有良好的临床效果。     

Staged operation of off-pump coronary artery bypass grafting using aortic connector system, and concomitant surgery for abdominal aortic aneurysm and gastric cancer; report of a case

Recently the patient of the atherosclerotic disease associated with malignant disease has been increased. A 75-year-old man was referred to our section with an infrarenal abdominal aortic aneurysm (AAA) and a gastric cancer (GC). Preoperative coronary angiogram revealed the significant stenoses of the right coronary and the left anterior descending coronary artery. We selected the staged operation of off-pump coronary artery bypass grafting (CABG) [OPCAB] and the concomitant surgery for the AAA and the GC. Operative invasion could decrease with the surgical procedure of the OPCAB and the concomitant surgery compared to the conventional CABG or the separate operation. We used the aortic connector system during OPCAB to prevent such the serious complications of the aortic dissection or the systemic embolism due to the calcified ascending aorta.     

Aortic connector for coronary revascularization in a patient with Takayasu''s disease

Takayasu's disease affects the aorta and its major branches including coronary arteries, some of which may require coronary artery bypass grafting (CABG). However, calcification of the aorta affected by Takayasu's disease often makes proximal anastomosis of a vein graft very difficult. In addition, since the major branches of the aortic arch are also frequently affected by it, the internal mammary arteries are unsuitable for use in CABG. We report a 60-year-old woman with stenosis of the left main coronary artery and heavy aortic calcification caused by Takayasu's disease whose severe angina was successfully relieved by off-pump CABG using mechanical aortic connectors for proximal vein graft anastomoses.     

非体外循环和体外循环冠状动脉旁路移植术在二次冠状动脉旁路移植术中的应用

目的研究对比在二次冠状动脉旁路移植术(re-CABG)患者中分别采用非体外循环和体外循环下冠状动脉旁路移植术(off-pump CABG和on-pump CABG)的临床早期结果,探讨通过合理手术方式的选择,提高re-CABG的手术疗效。方法自2000年4月到2006年6月,21例首次CABG后因心绞痛复发患者在阜外心血管病医院接受了re-CABG手术,其中10例行off-pump CABG(off-pump组),11例行on-pump CABG(on-pump组)。两组患者术前性别、年龄、体重、心肺功能、心绞痛程度、左心室舒张期末内径、射血分数、合并高血压、糖尿病等方面差异无统计学意义(P>0.05)。结果 On-pump组中患者术后死亡1例,冠状动脉远端吻合口数多于off-pump组(P<0.05);off-pump组无手术死亡,在手术时间、术后呼吸机辅助时间、胸腔引流液量、输血量和手术后住院时间等方面,均明显少于on-pump组(P<0.05)。结论 Off-pump CABG和on-pump CABG技术在re-CABG中都可以取得满意疗效,off-pump CABG下施行re-CABG安全可靠。     

Off-pump coronary artery bypass

OBJECTIVES: Off-pump coronary artery bypass grafting (CABG) on the beating heart has become popular procedure in cardiac surgery and its initial results appeared favorable. We report our early and mid-term results of off-pump CABG performed at Shin-Tokyo Hospital. METHODS: Medical records of patients undergoing off-pump or conventional on-pump CABG from September 1, 1996, to August 31, 1999 were retrospectively reviewed. Patients underwent off-pump CABG were further classified into 2 groups; MIDCAB (Off-pump CABG for single vessel revascularization via a small skin incision) and OPCAB (off-pump CABG mainly approached via midline sternotomy) group. Their preoperative, perioperative, and follow-up data were collected and analyzed. RESULTS: Among a total of 995 cases of CABG, 194 cases were off-pump CABG (male/female 142/52, mean age 66.9). The mean number of distal anastomoses in off-pump CABG was 1.9 +/- 0.9 (1.0 +/- 0.0 in MIDCAB and 2.3 +/- 0.7 in OPCAB), which was significantly fewer than in on-pump CABG (3.6 +/- 1.1), with p < 0.0001. Intubation time (5.3 +/- 5.7 hours in off-pump CABG vs 13.1 +/- 24.2 hours in on-pump CABG), ICU stay (1.7 +/- 1.1 vs 3.2 +/- 3.0 days), and postoperative hospital stay (14.0 +/- 7.9 vs 18.1 +/- 12.1 days) in off-pump CABG were significantly shorter than in on-pump CABG (p < 0.0001). In the off-pump CABG group, there were no in-hospital deaths and 14 major complications, fewer than in on-pump CABG (8 hospital deaths and 114 major complications). Postoperative angiography before hospital discharge was conducted in 80 patients (41.2%) and showed 2 occlusions, giving a graft patency rate of 98.6% in the off-pump group. During follow-up (0.9 +/- 0.6 year) period, there were 5 non-cardiac deaths and 20 cardiac events in the off-pump group. The actuarial survival rate at 36 months was 94.6% for off-pump CABG, showing no significant difference from the rate for conventional CABG patients (95.2% at 36 month, p = NS) The event-free rate was 84.0% at 36 months in off-pump CABG patients; however, which was less favorable than on-pump CABG patients (88.0% at 36 months, p < 0.05). CONCLUSIONS: Both in-hospital and mid-term results for off-pump CABG patients were acceptable. Isolated CABG can thus be safely performed without cardiopulmonary bypass. Advances in coronary stabilization have contributed to these improved results. The observed long-term cardiac events may be related to incomplete revascularization.     

Coronary artery spasm after off-pump coronary artery bypass grafting

BACKGROUND: Coronary artery spasm (CAS) in the immediate postoperative period has been recognized as a possible cause for perioperative myocardial ischaemia after off-pump coronary artery bypass grafting (CABG). It varies in severity and can be associated with circulatory collapse and death. The purpose of this study was to present our experiences on CAS after off-pump CABG and detail its management. METHODS: The case reports of three patients with similar clinical presentations of ischaemic heart disease who underwent CABG using an off-pump technique are reviewed. Severe manifestations of CAS in the immediate postoperative period with documented angiographic findings are presented. RESULTS: Three patients (two men and one woman) with angina pectoris were diagnosed with coronary artery disease using coronary angiography. The elective off-pump CABG was uneventful; however, severe manifestation of myocardial ischaemia with abrupt onset developed at the intensive care unit. All three patients underwent immediate coronary angiography to verify the diagnosis of CAS. Apart from intracoronary nitroglycerine infusion and medical support with inotropic agents, extracorporeal membranous oxygenation was carried out because of severe haemodynamic deterioration in one case, while support was required with intraaortic balloon pumping in another. All three patients made a full recovery. CONCLUSION: Coronary artery spasm can severely complicate the postoperative course for patients undergoing off-pump CABG, leading to myocardial ischaemia or infarction, life-threatening arrhythmias, persistent hypotension and even cardiac arrest. Early awareness and diagnosis of CAS with the establishment of appropriate management strategies may prevent its potentially lethal consequences.     

Characteristic changes in cerebral perfusion during on-pump and off-pump coronary artery surgery

Objective: We investigated the cerebral perfusion status during on-pump or off-pump coronary artery bypass grafting (CABG). Methods: We monitored somatosensory evoked potential (SEP) and regional cerebral oxygen saturation (rSO₂) as parameters of cerebral perfusion in an on-pump group (n=10) and an off-pump group (n=16). The percent changes from control values were calculated before, during, and after aortic clamping, and after weaning from cardiopulmonary bypass, in the on-pump group. In the off-pump group, these were calculated before, during, and after heart displacement for distal anastomosis. Results: In the on-pump group, the amplitudes of the SEP were significantly enhanced during and after aortic cross-clamping and were associated with a significant decrease in rSO₂. Latency was prolonged immediately after aortic cross-clamping, but was shortened afterwards. There was little change in these parameters throughout the operation, in the off-pump group. Conclusions: Cerebral perfusion remains stable during off-pump CABG. The etiology of a simultaneous increase in SEP amplitude and decrease in rSO₂ during the rewarming period in the on-pump group requires further investigation.     

Off-pump reduction aortoplasty and concomitant coronary artery bypass grafting

This report presents 4 off-pump reduction aortoplasty and concomitant coronary artery bypass grafting (CABG) cases. Severe left ventricular dysfunction, hemodialysis-dependent chronic renal failure, metastatic colon carcinoma, poor nutritional status, difficulties with early mobilization, and ascending aortic dilatation or aneurysm were the critical indications for off-pump reduction aortoplasty and concomitant CABG.     

胸主动脉瘤合并冠心病同期外科治疗(附15例报告)

目的 总结胸主动脉手术同期行冠状动脉旁路移植术的经验。方法1999年6月至2002年7月，胸主动脉瘤手术同期行冠状动脉旁路移植术15例，均为男性；年龄40～66岁，平均57．2岁；体重60～89kg，平均70．2kg。病种包括主动脉根部瘤5例、升主动脉瘤2例、弓部瘤3例、主动脉夹层5例。经胸骨正中切口在全麻低温体外循环下手术14例；左外侧切口非体外循环下冠状动脉旁路移植同期股股转流降主动脉置换术1例。结果术后早期30d内死亡1例，随访1～36个月，无远期死亡，无再次手术及冠心病相关事件发生。结论胸主动脉置换术与冠状动脉旁路移植术能够安全同期进行，同期冠心病的再血管化对预防冠心病相关事件的发生有积极作用。     

Neurological outcomes in coronary surgery: independent effect of avoiding cardiopulmonary bypass

BACKGROUND: Recent studies examining neuroprotective effects of off-pump coronary artery bypass grafting (CABG) have shown inconsistent results. We examined our database to quantify the independent effects of avoidance of cardiopulmonary bypass (CPB) and aortic manipulation on neurologic outcomes after CABG. METHODS: A total of 2,327 consecutive cases undergoing isolated CABG between April 1997 and May 2001 were identified at our two institutions. Patients were divided into three groups: on CPB, off-pump with aortic manipulation, and off-pump without aortic manipulation. To control for the confounding effects of other risk factors, we performed a multivariate logistic regression analysis. Potential covariates considered in the logistic model included age, sex, redo operations, diabetes, chronic obstructive pulmonary disease, neurologic disease, peripheral vascular disease, ejection fraction, and priority of operation. RESULTS: A total of 1,210 cases were performed on CPB, compared with 520 off-pump with aortic manipulation, and 597 off-pump without aortic manipulation. The incidence of focal neurologic deficit was 1.6% (n = 19) in the on-pump group, 0.4% (n = 2) in the off-pump with aortic manipulation group, and 0.5% (n = 3) for the off-pump without aortic manipulation group (p for trend = 0.027). The results of the multivariate logistic regression analysis demonstrated that use of CPB was a risk factor for focal neurologic deficit, with an odds ratio of 3.82 (95% confidence interval, 1.41 to 10.34; p = 0.005). Aortic manipulation did not significantly influence neurologic outcome in off-pump patients. CONCLUSIONS: Off-pump operation, with or without aortic manipulation, reduces adverse neurologic outcomes compared with on-pump procedures.     

Off-pump coronary artery bypass grafting: comparison between standard CABG and off-pump CABG

We have performed 321 cases of coronary artery bypass grafting (CABG), between October 15 1995 and November 20 2000. We have evaluated the operative results of 142 cases (44.2%) of conventional CABG and 179 cases (55.8%) of off-pump CABG performed during this period. The average numbers of bypassed grafts was 3.53 for conventional CABG, and 1.62 for off-pump CABG. The total number of 369 grafts were anastomosed to 501 coronary arteries for conventional CABG, and 283 grafts were anastomosed to 290 coronary arteries for off-pump CABG. RESULTS: Although two saphenous veins were occluded, the early postoperative patency rate was 100% for conventional CABG using RITA, LITA, GEA and RA. Three site of stenosis in 18 LITAs and 2 in 16 RITAs were recognized in off-pump CABG without the use of stabilizers. One site of stenosis in 130 LITAs and 3 string signs in 44 GEA were recognized in off-pump CABG with the use of stabilizers. Postoperative angiography in 52 off-pump CABG cases at one year later showed no new lesion. CONCLUSION: The use of stabilizers and LIMA suture enables adaptation of the MIDCAB procedure to a wider range of coronary artery bypass procedures, and a higher graft patency can be expected.