Total arterial, anaortic, off-pump coronary artery bypass grafting

Total arterial, anaortic, off-pump coronary artery bypass grafting is seen by many as a complex, specialized operation; however, when broken down into its component parts, it can be approached as multiple reproducible techniques that all trainees should master. These components include skeletonized mammary harvest, construction of composite arterial grafts and off-pump cardiac surgery. In this video tutorial, we describe step-by-step approaches to each of these elements and demonstrate how these principles come together to facilitate an excellent surgical outcome for the patient: revascularization of all diseased coronary arteries with arterial grafts while avoiding arresting the heart or aortic manipulation.