**5.4 Simple indigenous metallic stabilizer (SIMS)**

We have been using our own simple indigenous (Indian made) metallic stabilizer (SIMS) for the last 5 years or so (**Figure 16**, stabilizer and pods). It was innovated to avoid the conventional disposable plastic stabilizer that had to be changed either after every case or like in India, to change it after 10 or 20 cases. Hence we developed our own reusable, re-sterilisable metallic stabilizer, which we have used for the last 5 years even without changing the main part. The only part that has to be changed is the Pods. The pods would cost about 10–15 dollars for one pod. This has in fact reduced our carbon footprint which we leave when we do cardiac surgery [9].

The link of videos showing the SIMS in action: https://www.youtube.com/playlis t?list=PLmvb6npEfabinhlatq8IYLBz8WlHo8bu1.

**103**

**6. Conclusion**

*Revascularisation Strategies in OPCAB (Off Pump Coronary Artery Bypass)*

absolutely needed, like in positioning for right coronary artery grafting.

Revascularisation strategy is the most important part of planning for

any patient who has undergone OPCAB in out centre, over the last 15 years.

CABG. Whether it is done on the heart lung machine, or it is performed without the use of heart lung machine, it is important to first deliver a patent anastomosis. Just because some surgeons are able to do a good job, does not mean that everyone can do it. Hence one has to tailor make his own strategy of coronary revascularisation. Only by performing more and more such procedure, can we become confident on that technique. Just because the studies tell that arterial grafts have a better long term patency, and if we by performing this surgery on a patient are not able to provide a safe surgery, we should not do it. No wonder only 5% of surgeons perform total arterial grafting, and that only a handful of surgeons perform them on all patients. Likewise, just because we have been performing OPCAB in 100% of our patients over the last 12 years and that we have had no conversions on to the pump, does not mean that it is possible for all surgeons to do it [10]. Unless they have a mind-set and work hard for it to happen and that the team has been geared to perform without much issues, OPCAB would not be possible. It is important to watch such a team perform, by staying with them for at least a few weeks to learn this technique. Once the OPCAB technique is mastered, we could then strategize on what conduits to use and what permutations and combinations of conduits could be used. If we are able to perform a good OPCAB procedure then there is no need to use inotropes post operatively and that the hospital stay itself gets shortened. We have totally avoided inotropes in

The SIMS comes as a combo device (**Figure 17**, shows the box, which comes with the sternal spreader and the stabilizer and its parts), which is made of a sternal spreader with a railing on both sides over which a vertical 2 inch metallic rod could be fixed with a screw and its position could be moved according to the position of the coronary artery which needed to be bypassed. Over this metal rod, we have the stabilizer rod that is fixed at its base with another clamp, which in turn could be moved over the metal rod to which ever position we need. The stabilizer rod is in fact a curved hollow metallic tube which houses another curved metal rod inside. The curved outer tube has a distal metal end that holds a housing in which the pod head could be moved around. This housing has three slots which allows the pod to move in them until it is positioned. The proximal end of the outer tube has a screw which when screwed, would tighten the inner rod. The inner rod at its distal end is convex and this moves on the concave end of the interlocking rod in front of it. The interlocking rod is the crux of the stabilizer (sent for patenting). This is a half a centimetre piece of metal which is concave on both ends. The proximal concave end allows the metal rod to push it forward or distally, and the distal concave bit allows the head of the pod to rest on it. Hence when the pod is placed parallel to the coronary artery, we first tighten the rod in the intended position and the pod is positioned by tightening the screw at the proximal end. This screw in turn pushes the inner rod forward, which in turn pushes the interlocking rod which tighten and stabilizes the head of the pod in the desired position. This, once positioned is so stable that it does not move at all. The pod has suckers like in the conventional stabilizers, which could be attached to the suction apparatus and can be used as suction stabilizer as well. Over time, once we get used to the stabilizer we can avoid the suction unless it is

*DOI: http://dx.doi.org/10.5772/intechopen.88102*

#### *Revascularisation Strategies in OPCAB (Off Pump Coronary Artery Bypass) DOI: http://dx.doi.org/10.5772/intechopen.88102*

The SIMS comes as a combo device (**Figure 17**, shows the box, which comes with the sternal spreader and the stabilizer and its parts), which is made of a sternal spreader with a railing on both sides over which a vertical 2 inch metallic rod could be fixed with a screw and its position could be moved according to the position of the coronary artery which needed to be bypassed. Over this metal rod, we have the stabilizer rod that is fixed at its base with another clamp, which in turn could be moved over the metal rod to which ever position we need. The stabilizer rod is in fact a curved hollow metallic tube which houses another curved metal rod inside. The curved outer tube has a distal metal end that holds a housing in which the pod head could be moved around. This housing has three slots which allows the pod to move in them until it is positioned. The proximal end of the outer tube has a screw which when screwed, would tighten the inner rod. The inner rod at its distal end is convex and this moves on the concave end of the interlocking rod in front of it. The interlocking rod is the crux of the stabilizer (sent for patenting). This is a half a centimetre piece of metal which is concave on both ends. The proximal concave end allows the metal rod to push it forward or distally, and the distal concave bit allows the head of the pod to rest on it. Hence when the pod is placed parallel to the coronary artery, we first tighten the rod in the intended position and the pod is positioned by tightening the screw at the proximal end. This screw in turn pushes the inner rod forward, which in turn pushes the interlocking rod which tighten and stabilizes the head of the pod in the desired position. This, once positioned is so stable that it does not move at all. The pod has suckers like in the conventional stabilizers, which could be attached to the suction apparatus and can be used as suction stabilizer as well. Over time, once we get used to the stabilizer we can avoid the suction unless it is absolutely needed, like in positioning for right coronary artery grafting.
