How I do it: a novel method that provides simultaneous coronary artery occlusion and retraction for beating heart bypass surgery.

Background: Coronary artery stabilization and retraction have been a crucial problem in beating heart bypass surgery. Conventional methods such as looping and suspension of the target artery carry risk of coronary artery damage. Above all, these methods do not aid in retraction in coronary arteriotomy. Methods: Five mongrel dogs were used in this study. After intratracheal general anesthesia, median sternotomy was performed, and the left anterior descending coronary artery (LAD) and right coronary artery (RCA) were chosen as target vessels. To stabilize epicardium we passed the proximal portion of each coronary artery with a pledgeted suture parallel to the orientation of the coronary artery through the arteriotomy. After a similar suture was passed on the distal side, pledgets were placed on both sides of the incised coronary artery, and tourniquets were applied and snared just after opening of the target coronary artery for occlusion of proximal and distal flow. The tourniquets also were pulled up at an angle of 45 degrees on both sides for stabilization of the epicardium and retraction of the arteriotomy edges. Results: All instances of snare-induced coronary occlusion and retraction were analyzed (10 coronary snares in 5 dogs, the RCA and the LAD of each dog being used). Flow in the coronary artery was stopped, and visualization of the arteriotomy was successful. Conclusions: We described a novel technique of temporary coronary artery stabilization and occlusion that provided simultaneous retraction in coronary arteriotomy. This procedure resulted in a clean and retracted operative field for suitable anastomosis even in the arteriotomy edges.