This is a video by Professor Tristan Yan, who performs a total arterial anaortic off-pump bypass procedure, without manipulating the ascending aorta, which reduces the risk of stroke. He first anastomoses the left radial artery to the left internal mammary artery (LIMA) in an end-to-side fashion, as a “T” graft. Then after performing the LIMA to diagonal and left anterior descending artery sequential anastomoses, he shows how to position the heart in order to achieve a stable and reproducible access to the obtuse marginal branch, and the posterior left ventricular branch, before doing the posterior descending artery grafting. The key step in preparation is to incise the pericardium longitudinally on the right side, down towards the anterior aspect of the inferior vena cava. This simple step allows the heart to be rotated into the right chest while grafting the lateral wall, without compromising the preload of the heart.
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