Where to place the deep stitch in OPCAB?

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This post clarifies in a scientific manner the exact positioning of the deep stitch supporting the left ventricle at enucleation.

Dear Colleagues,

The exact positioning of the deep stitch is unclear for many and often confusing. One can place the deep stitch on the left pericardium (1) at several places, one can use the little rim just lateral of the two left pulmonary veins (2), one can place it under the left and right pulmonary veins or completely under the left atrium (3).

The movement we want to obtain is a rotation of the left ventricle and an upwards movement of the left ventricle, without elongation of the myofibrils. Newton's law nr 2 states that the more you move to the left of the picture (the longer (b), the higher the load will be lifted. In addition places 1 and 2 very often create mitral valve incompetence (as can be seen on the TEE).

So we propose to place the anchor of the tape UNDER the left atrium. in between the four pulmonary veins.

This is all very well explained in the course. Then one enucleates the heart (see video in the course)

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