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Invited Commentary

University Hospital Utrecht Department of Cardio-Thoracic Surgery Room E03.406 Utrecht 3508 GA, The Netherlands

The no-touch principle in CABG is certainly crucial for high patency rates. In off-pump CABG, visualization of the anastomosis site is a condition sine qua non. In this report of a no-touch method for off-pump coronary artery bypass grafting, the authors employed the no-touch procedure successfully in 12 patients for constructing22 anastomoses. No angiographic follow-up data are available.

Visuflo is a great help, as it illuminates and delivers (moist) air spurts at the same time. A major disadvantage of this technique is that the bleeding from the arteriotomy, whether as residual flow or distal back-bleeding, causes malperfusion of the locoregional myocardium and thus may create hemodynamic instability.

Effective, atraumatic temporary segmental coronary occlusion using bulldog clamps, snares, tapes, and intraluminal shunts or occluders yields a dry anastomosis site and helps to preserve the distal myocardium. Therefore, these should be considered as the primary modalities, with the blower/mister as an adjunct and not the other way. A word of caution against the use of dry-air blowing: this may cause dessication and intima loss. Gentle, short, moist-air spurts seem more appropriate.

However, I disagree with the authors that mechanical stabilization is traumatic. Apart from superior immobilization, there is ample evidence that the dedicated modern stabilizers are atraumatic and that they are the key to successful off-pump CABG in selected patients nowadays (and at low cost when reusables are employed).^1–4

	REFERENCES

TOP REFERENCES

 

1. Borst C, Jansen EWL, Tulleken CF, et al. Coronary artery bypass grafting without cardiopulmonary bypass and without interruption of native coronary flow using a novel anastomosis restraining device (‘Octopus’). J Am Coll Cardiol 1996;27:1356–64.[Abstract]

2. Boonstra PW, Grandjean JG, Mariani MA. Improved method for direct coronary grafting without CPB via anterolateral small thoracotomy. Ann Thorac Surg 1997; 63:567–9.[Abstract/Free Full Text]

3. Jansen EWL, Borst C, Lahpor JR, et al. Coronary artery bypass grafting without cardiopulmonary bypass using the ‘Octopus’ method: results in the first 100 patients. J Thorac Cardiovasc Surg 1998;116:60–7.[Abstract/Free Full Text]

4. Calafiore AM, Di Giammarco G, Teodori G, et al. Midterm results after minimally invasive coronary surgery (LAST operation). J Thorac Cardiovasc Surg 1998;115:763–72.[Abstract/Free Full Text]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Erik WL Jansen Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jansen, E. W. Search for Related Content PubMed Articles by Jansen, E. W.