Surgery Today

, Volume 48, Issue 5, pp 566–570 | Cite as

Segmental clamp and distal perfusion technique for reducing myocardial ischemia during coronary onlay grafting on a beating heart

  • Naoki Minato
  • Takayuki Okada
  • Shinya Kanemoto
  • Nobuya Zempo
How To Do It


We present a segmental clamp with distal perfusion technique to reduce myocardial ischemia during onlay grafting, on a beating heart. After a proximal coronary arteriotomy for 2–3 cm, the distal artery is perfused through a cannula, with femoral arterial blood (distal perfusion with external shunt). During proximal and distal coronary snare clamping with distal perfusion, onlay anastomosis is performed, from the heel toward the point of cannula insertion. We then move the proximal clamp to the onlay area and open the graft, to get early proximal coronary reperfusion. The arteriotomy is extended, and this procedure is repeated to achieve complete beating heart onlay anastomosis. We safely performed this procedure on the beating heart off-pump or on-pump in 95 patients with no perioperative myocardial infarction, no intraoperative hemodynamic deterioration, no 30-day mortality. This technique reduces regional myocardial ischemic and secures the safety for onlay grafting on the beating heart.


Coronary onlay grafting Coronary endarterectomy Off-pump coronary artery bypass grafting 




Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Naoki Minato
    • 1
  • Takayuki Okada
    • 1
  • Shinya Kanemoto
    • 1
  • Nobuya Zempo
    • 1
  1. 1.Department of Cardiovascular SurgeryKansai Medical UniversityHirakata CityJapan

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