Future technology for off-pump coronary artery bypass (OPCAB).

Over the past 5 years, many coronary artery surgeons have embraced technology and advanced the field of beating heart surgery to the point where off-pump coronary artery bypass (OPCAB) is becoming a mature procedure. Enabling technologies are now available for all stages of the procedure, including cardiac positioning, coronary artery stabilization, coronary artery visualization, and performance of the proximal and distal anastomoses. Despite these successes, only a minority of cardiac surgeons performs this procedure routinely. Proponents of OPCAB and the medical device industry will need to continue to develop new technologies to make OPCAB less technically challenging and more widely accepted. Progress towards routine single-vessel off-pump totally endoscopic coronary artery bypass has been slow. Translating the benefits of multivessel OPCAB to an endoscopic setting remains a formidable challenge that will require further technologic breakthroughs.