Complete Arterial Revascularization


Schematische Darstellung der komplett arteriellen Revaskularisation



The trend in coronary surgery is clearly towards complete arterial revascularization. Whenever possible, we try to avoid the use of the cardiopulmonary bypass (OPCAB = off-pump coronary artery bypass). The patency of arterial bypass is clearly superior to those of vein grafts. By avoiding cardiopulmonary bypass and performing the operation in the so-called aortic non-touch technique, the risk of stroke can be almost completely avoided.

A complete arterial coronary revascularization can almost be performed using both skeletonized mammary arteries. In the Albertinen Cardiovascular Centre, the rate of complete arterial revascularization is for several years up to more than 93 percent (average of all german heart centres 23,5 %; DGTHG statistic 2014).


Both internal mammary arteries are harvested in a skeletonized fashion, which means that  accompaning veins, nerves and surrounding tissue are preserved. Advantages include improved arterial circulation of the sternum and preserved venous back flow resulting in less wound infections.

Furthermore damage of nerves with subsequent sensory disturbances are avoided. Especially patients with diabetes mellitus benefit from the skeletonizing technique by much lower risk of sternal wound infection.

The use of the so-called t-graft enables a complete arterial revascularization in nearly all patients. Using this technique both mammary arteries are dissected in a skeletonizing technique. The left mammary artery left in situ is used for the front coronary branches, such as LAD and diagonal branches, typically in a sequential grafting technique. The right mammary artery (RIMA) is used as a so-called free graft and implanted into the left mamammary artery in a 90 degree angle (t-graft). By this graft the posterior coronary arteries (circumflex artery, marginal branches, right coronary branches) are revascularized sequentially.

Whenever possible the operation is performed in a minimally invasive approach, avoiding the heart lung machine with all its negative side effects (neurological complications, elevated blood consumption, increased wound infection etc.). Thus, 70 % of isolated coronary artery bypass surgery in our department is performed without the use of cardiopulmonary bypass on the beating heart (average of all german heart centres 18,1 %; DGTHG statistics).



Results and Figures




Schematic presentation of the complete arterial revascularization

In most cases, we preferred surgical procedure as the complete arterial revascularization without the use of cardiopulmonary bypass (OPCAB) after median sternotomy and preparation of both internal mammary arteries. The right internal mammary artery (RIMA) is used as a t-graft and implanted in the LIMA bypass. The positioning of the heart during revascularization is enabled by deep pericardial sutures. Then the affected coronary vessel is snared with 2 air-filled vessel loops and then immobilized in a combination with a special stabilizing instrument, developed in our department.  The high quality of stabilization enables us to sew anastomoses between coronary bypass and coronary vessels with great accuracy. Alternatively other stabilizing instruments are used.


The indication for minimally invasive complete arterial off-pump coronary procedures is basically in all isolated coronary surgery. In particular, older high-risk patients with severe comorbidities, such as chronic renal failure, neurological comorbidities, insulin dependent diabetes mellitus and other comorbidities benefit from this surgical procedure. Additionally, patients with recent myocardial infarction or heavily calcified ascending aorta (porcelain aorta) can be operated with low risk with this surgical approach.


Menu "Selected Surgical Techniques"


■ Coronary Bypass Surgery

■ Complete Arterial Revascularization

■ Treatment of Chronical Artrial Fibrillation with Radio Frequency Ablation

■ Aortic Valve Surgery

■ Aortic Valve Repair

■ Mitral Valve Surgery

■ Surgery of Aortic Aneuryms and Endoluminal Stenting

■ Assist Systems








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World Premiere at Albertinen Cardiovascular Centre

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Reception, Accommodation, Care

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Scientific Projects and Research

In addition to the best possible patient care scientific projects are carried out to improve methods of treatment. > Learn about our research





25 Years Heartmedicine at Albertinen Cardiovascular Centre

Cardiac surgery, interventional cardiology and cardiac anaesthesia at Albertinen Cardiovascular Centre in Hamburg are celebrating their 25th anniversary this year. The first heart operation here was performed on July 2, 1991. > read more 








Prof Dr Friedrich-Christian Rieß, MD
Chairman of the Albertinen Cardiovalcular Centre
Chief Physician Cardiac Surgery
Phone +49-40-5588-2445

curriculum vitae | publications




Süntelstraße 11a · 22457 Hamburg


Mrs. P. Schlizio
Phone +49-40-5588-2442
fax +49-40-5588-2421




Mrs. S. van Oers
Phone +49-40-5588-2453
fax +49-40-5588-2421




Mrs. K. Borchert

Phone +49-40-5588-2445
fax +49-40-5588-2421





Prof Dr Joachim Schofer, MD
Head of the Department for Percutaneous Treatment of Valvular Heart Disease
Phone +49-40-5588--2442 /-2453 /-2445





Mrs. A. Prach
Phone +49-40-889 00 91 52
Fax +49-40-889 00 99 33





Dr L. Hansen, MD
Deputy Physician Cardiac Surgery
Phone +49-40-5588-2445




S. Winkel
Deputy Physician Cardiac Surgery
Phone +49-40-5588-2445




J. Stripling
Deputy Physician Cardiac Surgery
Phone +49-40-5588-2445




Daniel Silva
Senior Physician Cardiac Surgery
Phone +49-40-5588-2445 



Dr G. Horoschun, MD
Deputy Physician Cardiac Surgery Intensive Care C2h 
Phone +49-40-5588-2550 



Dipl. Ing. R. Binczyk
Chief Perfusionists

Phone +49-40-5588-2569
fax +49-40-5588-2569





B. Kliche
Head Nurse Cardiac Surgery
Phone +49-40-5588-6715





Matthias Scheller, CEO of Albertinen Diakoniewerk e.V., congratulates the founding father of Albertinen Cardiovascular Centre, Professor W. Füllbrandt and the men of the first hour at the anniversary "25 Years Heart Medicine at Albertinen-Hospital"



From left: M. Scheller, Prof. W. Füllbrandt, Prof. F.-C. Rieß, J. Kormann, Dr. P. Kremer, Prof. N. Bleese. Photo: Andreas Riess




July 1, 2016 - Tobias Schwarz, CEO of Albertinen hospital, congratulates Mr. Joachim Kormann, Dr. Peter Kremer, MD, Mr. Stephan Winkel and Dr Christine Löwer, MD (from left) marking the 25th anniversary of service.



Photo: Andreas Riess