**OPCAB is particularly beneficial for:**


• Proximal anastomosis can also be done on the arrested heart with single aortic

• If the heart is in sinus rhythm, then start weaning off CPB.

• Graft flow could be checked with flow meter device.

• Protamine is given to reverse the effect of heparin.

• One mediastinal and one left pleural drains are inserted.

They should avoid patients with unfavorable characteristics:

• Cardiomegaly-making exposure of lateral and inferior walls difficult

• Small (<1.5 mm diameter), intramyocardial, and diffusely diseased vessels

• The skin and subcutaneous tissue are closed in layers with vicryl sutures.

• Decannulation is done and bleeding secured.

*Side-biting clamp on the ascending aorta for proximal anastomosis.*

*The Current Perspectives on Coronary Artery Bypass Grafting*

• Temporary pacing wire is placed on RV.

**6.2 Off-pump CABG (OPCABG) technique**

• Sternum is closed with wires.

*6.2.1.1 Beginner beating heart surgeon*

*6.2.1 Patient selection*

**94**

cross clamp [14],

**Figure 13.**

