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Less invasive surgeries are becoming necessary because the world s increasingly older populations are becoming viable candidates for coronary artery bypass operations. Because of the technical difficulty, the percentage of off-pump coronary artery bypass (OPCAB) in coronary artery bypass graft (CABG) surgery CABG is still low in the US and Europe. However, in Japan OPCAB is the standard CABG, making up more than 60% of all CABGs. In addition, the operative mortality in primary elective OPCAB is very low (less than 1% in 2010). Moreover, the trend of utilizing arterial grafts has produced excellent long-term outcomes. This book first describes the state of the art of OPCABs performed by Japanese surgeons with the Kaizen Mind and explores the techniques and approaches that explain why OPCABs are such a huge success in Japan.