The most commonly used surgical coronary revascularization technique is the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery and reversed long saphenous vein to other arteries, performed using cardiopulmonary bypass on an arrested heart. However, there are two significant drawbacks of this “on-pump” technique, relating to graft failure and stroke. Firstly, saphenous vein grafts have well-known early and late failure issues, in contrast to established evidence of long-term benefits from the use of total arterial grafting strategies. The second drawback is the relatively high rate of neurological injury (i.e. stroke) with the use of heart and lung machine, particularly in high-risk or older patients.
Professor Yan routinely offers his patients off-pump coronary artery bypass surgery without manipulating the ascending aorta (“anaortic”) utilizing total arterial grafts, in order to reduce the stroke risk and achieve long-term benefits for his patients.
Video 1. In this video, Professor Yan demonstrated a safe technique for performing surgical revascularization that avoids cardiopulmonary bypass, avoids all manipulation of the ascending aorta, and uses all-arterial grafts to achieve complete surgical revascularization.
Critics of off-pump coronary artery bypass grafting (OPCAB) argue that increased technical difficulty of the technique may result in reduced graft patency. The results of some clinical trials comparing off- vs. on-pump CABG, performed by relatively inexperienced OPCAB surgeons have demonstrated inferior results for patients undergoing OPCAB surgery. However, this is not the case in high-volume surgeons and surgeons with expertise in OPCAB surgery, as the 5-year CORONARY trial data have demonstrated.