**6. Conclusion**

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**102**

**Figure 17.**

**Figure 16.**

*Shows stabilizer with pods.*

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

*Shows combo device, which comes in a box.*

t?list=PLmvb6npEfabinhlatq8IYLBz8WlHo8bu1.

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

Revascularisation strategy is the most important part of planning for 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 any patient who has undergone OPCAB in out centre, over the last 15 years.

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