“Single suture” for circumflex exposure in off-pump coronary artery bypass grafting

Exposure of coronary vessels in the circumflex territory for surgery off cardiopulmonary bypass (CPB) is a challenge. Ricardo Lima from Brazil described a series of sutures that enable surgeons to expose the marginal circumflex vessels on the beating heart. We have modified this technique and only use a “single suture” placed in the oblique sinus of the posterior pericardium. This allows for successful exposure of all coronary vessels with minimal manipulation of the heart. This simple technique enhances surgery on the beating heart and is especially useful to bypass topographically “difficult” posterior and lateral coronary vessels.