During coronary coronary artery bypass graft (CABG) surgery on the beating heart, a major challenge lies in suturing the graft onto the moving heart. The surgeon needs a stabilizing device to steady this area of the heart.The stabilizing device consists of a heart positioner and a tissue stabilizer.This video (in German) shows a quadruple bypass procedure on the moving heart, called off-pump coronary artery bypass (OPCAB), with total arterial revascularization (TAR). Both internal thoracic arteries arteries are used as grafts.OPCAB is the standard procedure for surgical revascularization at the MediClin Heart Centre Lahr/Baden since 2005.There are considerable advantages to avoiding cardiopulmonary bypass with the use of a heart-lung machine (HLM). Using the HLM entails contact with foreign materials, triggering a nonspecific inflammatory response.This inflammatory response can cause capillary leak that can present a danger to organ functions (lung, liver, kidneys) in some circumstances.Another, even greater advantage is that no access to the ascending aorta is required ("no touch"). Especially in the elderly population, this part of the aorta often demonstrates arteriosclerosis.During conventional bypass surgery, cannulation or cross-clamping of the aorta can lead to displacement of small, calcified particles that can cause occlusion of cerebral arteries and stroke.In contrast to surgery with cardiopulmonary bypass, the area where the bypass graft is to be attached needs to be steadied temporarily, with the help of a stabilizer (OCTOPUS®).The positioner (STARFISH®) at the cardiac apex locks the longitudinal axis of the heart, thereby allowing access to coronary vessels of the lateral and posterior walls. During the entire time of the procedure, intraluminal shunts secure the blood flow through the coronary vessels. Despite higher skill requirements, the duration of this procedure is not prolonged, compared to conventional CABG surgery.So far, the results have been promising, with advantages especially for elderly patients with a high degree of arteriosclerosis.