In a majority of patients, off-pump complete coronary artery revascularization is an acceptable alternative to conventional operations, yielding good results given progressive experience, rigorous technique, and adequate coronary artery stabilization.

We report the successful management of a gigantic circumflex coronary artery aneurysm with fistulisation into the coronary sinus. Transoesophageal echocardiography allowed continuous visualisation of ventricular wall motion during dissection and closure of the aneurysm whilst operating on cardiopulmonary bypass on the beating heart.

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HLT recipients bridged by MV or ECMO have increased short-term and long-term mortality. Further studies are needed to optimize survival in these high-risk patients.