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It is certain that the development of cardiac surgery was mainly based on the use of the extracorporeal circulation machine.

A machine that is connected during the operation, through tubes, to the patient and substitutes the function of the heart and lungs. In this way, it becomes possible to stop the function of the heart and work in a bloodless and immobile surgical field.

However, the inflammatory reaction of the body and the secretion of toxic substances caused by the contact of the shaped components of the blood with the machine’s connection tubes, the oxidative stress from the reperfusion of the heart after complete ischemia and the mechanical damage that can occur at the connection points of the tubes and the large vessels of the heart (hemorrhages, injury), are mainly the complications that maintain the mortality of these operations, even today, at 2-8%.

The only real development in the last 20 years can be considered the ability that we as cardiac surgeons have to operate without using the extracorporeal circulation machine, thus avoiding the complications that arise from its application.

This development has found suitable ground mainly in coronary bypass operations, the well-known bypass. That is, the bypass of blocked or narrowed coronary vessels, the vessels of the heart that are located on its outer surface.

With sophisticated surgical tools called stabilizers, we keep the parts and vessels of the heart that we want to re-blood, immobile, and with prepared grafts that we take from the patient himself, we bypass the stenosis that has been created by coronary disease. In other words, we restore the blood supply to the vessel.

It has been proven in multicenter studies that the operating room time, the need for blood transfusion, as well as the stay in the ICU and the hospital are reduced. The patient is mobilized immediately, on the first postoperative day, and complications in the respiratory system, kidneys and brain are minimized, as well as infections, arrhythmias and neurological disorders (*1).

The results of this technique have been shown to be directly related to the experience of the surgeon and the surgical team. It is not an operation that can be performed by all surgeons.

The reason is that it cannot be easily reproduced and the learning period is long. That is why the initial enthusiasm for this technique stopped, resulting in very few cardiac surgeons continuing to serve it (*2).

Those who benefit most from this technique are:

• High surgical risk patients with heart failure. It has been shown that the higher the surgical risk, the better the results with a beating heart (*3)
• over 75 years of age
• with atherosclerotic aorta
• with COPD
• diabetics
• kidney patients
• on antiplatelet therapy
• with peripheral angiopathy
• patients who do not accept blood transfusions
• reoperations

In our center, the combination of this technique and the faithful application of the official guidelines of the international cardiac surgical societies for the use of arterial grafts (two mammary arteries mainly) and the avoidance of aortic manipulations, has led to excellent results.

Since 2014, the Athens Medical Center has supported our effort with modern biomedical equipment, experienced and specialized nursing staff, which, combined with our excellent results, make our center unique.