How to start a beating heart coronary artery surgery program.

An important issue that is not addressed in the recent literature on beating heart coronary artery bypass surgery is the question of how to initiate a program in OPCAB in a center where conventional coronary artery surgery has been the routine. It is the aim of this article to describe what we consider to be safe steps for a conventional cardiac surgeon to take to ensure a successful initiation of OPCAB surgery in his or her institution. While modern OPCAB surgery has experienced major technical advances that have made the procedure more predictably successful than in previous years, these advances require the use of an array of new technology and skills. This article discusses some of the skills and devices, such as modern stabilizers, shunts, and blowers, that the beginning OPCAB surgery team will need to acquire and master when embarking on an OPCAB program. Initiation of an OPCAB program also requires that the entire surgery team believe in the efficacy of the procedure and approach it with enthusiasm. A team visit to a center that already performs OPCAB is an important element in initiating the new program. It is no longer necessary to learn the procedures by trial and error. Because it will occasionally be necessary to convert from OPCAB to conventional surgery, the team must be thoroughly familiar with both methods and should not be reluctant to rely on the heart-lung machine when the patient's safety requires it.