Off-pump complete myocardial revascularization for three-vessel disease is often limited by the difficulty to approach the obtuse marginal branches. A method of coronary artery bypass grafting without cardiopulmonary bypass used in a high risk patient with left main stem and three-vessel disease is described.
Louagie, Y., Gonzalez, M., & Schröder, E. (1999). Off-pump myocardial revascularization for left main stem disease in a high-risk patient. Acta Chirurgica Belgica (Bilingual Edition), 99(6), 309-311. https://hdl.handle.net/2078.5/130754 (Original work published 1999)