Off-pump anastomosis of the left internal mammary artery to the left anterior descending coronary artery through a left inferior J-hemisternotomy.

Abstract Since the 1990s, a large body of literature has been published regarding minimally invasive coronary artery bypass grafting. Varying techniques, complexity of the procedures and the necessity of patient selection have led to its inconsistent application. We describe the standardized technique of left internal mammary artery grafting to the left anterior descending coronary artery, off-pump through a left inferior J-hemisternotomy (JOPCAB). This approach is straightforward, safe, effective, and replicable in virtually all patients. JOPCAB requires no patient selection or other prerequisite than experience in standard off-pump technique. The left internal mammary artery is harvested under direct vision through a left inferior J-hemisternotomy. The left anterior descending coronary artery is exposed with left-sided pericardial stitches. The off-pump anastomosis is performed with the aid of a suction stabilization device and routine intracoronary shunting. Patients are fully heparinized during the procedure.