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With an updated browser, you will have a better Medtronic website experience. Update my browser now. Beating heart bypass surgery or off pump coronary artery bypass OPCAB is a safe and proven option to conventional bypass surgery. Doing surgery on a beating heart eliminates the need for the heart-lung machine. This can result in fewer side effects. The majority of OPCAB surgery patients have improvement or complete relief of their symptoms and remain symptom-free for several years.

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Coronary artery bypass surgery is one of the most common surgical procedures in the United States. Your risk of death from the surgery is usually very low. As with any surgery, there are risks involved. The risks are no greater for off-pump heart bypass surgery than for conventional bypass surgery. These risks can include but are not limited to:. If you are facing cardiac surgery of any type, discuss these risk factors with your doctor to determine the best treatment for you.

Karamanoukian, H, et al. Decreased incidence of postoperative stroke following off-pump coronary artery bypass. J Am Coll Cardiol. Newman, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. Diegler A, et al. Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation.

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Ann Thorac Surg. Basker Rhao B, et al. Evidence for improved cerebral function after minimally invasive bypass surgery. J Card Surg. Success comes to those who quickly identify and systematically eliminate risks in the right order, using the right level of resources and the right methods. New ventures fairly bristle with risks. If managers attempted to eliminate all of them, the products or services would never get to market.

In considering how to answer that question, we have found it useful to think in three broad, sometimes overlapping categories: deal-killer risks, path-dependent risks, and easy-win, high-ROI risks.


As the name implies, these are uncertainties that, if left unresolved, could undermine the entire venture. Such risks may be less obvious in the moment than they appear in hindsight, after catastrophe has struck. For example, a colleague of ours was an early employee at a start-up satellite radio company aimed at consumers in the developing world.

The premise of the venture was that satellite broadcasting technology would be a relatively cost-effective way to bring mass media to markets that lacked infrastructure. Market research suggested that a huge latent need would turn into a booming business. The company deftly negotiated broadcasting licenses in several developing countries and solved a number of complex technological challenges.

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Nevertheless, the business imploded. What was the problem? The radio receiver required complex features such as multimode playback, a keypad for ordering subscription services, and—worst of all—professional installation, which made the device unaffordable in most of the developing world.

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The business limped along before ultimately going bankrupt. The company should not have left this key deal-killer assumption so utterly untested until late in the life of the venture. Quick-hit market research and rapid prototyping could have provided early warning signals. Rare is the new venture that never has to confront strategic forks in the road to success. Path-dependent risks arise when pursuing the wrong path would involve wasting large sums of money or time or both.

For example, consider the question confronting E Ink, a supplier of electronic paper display technologies in Cambridge, Massachusetts. Each option had different technical, marketing, and distribution requirements; if the company chose wrong, it risked misallocating millions of dollars. Rather than choosing one path and hoping for the best, E Ink reduced the cost of pursuing all three by outsourcing its marketing and production capabilities and then focused on resolving the risks associated with the core technology for all three applications.

Even after entrepreneurs have considered both deal-killer and path dependent risks, many uncertainties will remain on the table. But the more risks that can be eliminated, and the faster they can be removed, the greater the odds of success. For example, one of the earliest experiments that Reed Hastings, the founder of Netflix, conducted in developing his movie-rental-by-mail business was to mail himself a CD in an envelope. Perhaps the most dangerous result of injecting too much money too soon into a venture is that it creates a confirmation bias in the minds of venture managers.

Instead of testing their assumptions, they become more and more invested in confirming them. These are designed to pinpoint a deal-killer or path-dependent risk. Examples might include running tests on battery life before launching a new portable device, checking for toxicity in a drug before running full-scale efficacy tests, and testing bandwidth and connectivity concerns before launching an online learning program at various locations across the country.

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These are designed to test how various elements—the actual business model and operations—work together. In essence, they involve launching the business, or some part of it, in miniature. Although pilot programs are nothing new, our experience suggests that entrepreneurs rarely give them sufficient time to play out. From the beginning Kennedy intended to take his concept nationwide, but he started with just three restaurants.

For almost an entire year he focused on sharpening the concept and making it work on a small scale. Today the chain has more than locations in 18 states. An integrated experiment may be a pilot, a test-site location, a prototype, or any other trial operation. Targeted experiments such as surveys and focus groups can provide insights, but those that come from placing the product in a sales channel where customers make actual purchase decisions are often much deeper.

Fail to spot a deal-killer risk, and your venture is doomed.

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Fail to address a high-ROI risk in an orderly way, and you may transform a temporary setback into an insurmountable obstacle. Such was the fate of a start-up we worked with that targeted the nascent medical tourism market. Several deal-killer risks faced the venture. Unfortunately, rather than tackling them early, by beginning with those that could be tested most quickly and at the least cost, team members plunged into a time-consuming and expensive effort.

To gauge demand, they conducted a series of long interviews with Fortune corporate benefits managers and insurers around the country. Things looked very promising. The first involved a seminar to introduce the concept to prospective patients.

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The second involved several phone calls to U. In only two weeks and at virtually no expense , the team learned that patient demand was actually quite tepid and limited to a very narrow band of procedures, and that U. By failing to address their greatest risk—that no market existed for their services—in the cheapest and fastest way, the team members wasted significant resources and missed a critical opportunity to redirect their strategy to something more promising, such as a venture restricted to regional medical travel within the U.

S or travel to a close international destination like Mexico. A common mistake is to focus on one key risk to the exclusion of others. Sometimes you must be satisfied with partial risk resolution in one area, even as you start to consider and work on risk in another. You can then confirm a rough price point at which customers can be served, even as you continue to reduce related technical risk.

The more money that is sunk into a project at the outset, the less patience the company tends to have and the more people believe in the validity of their original approach, even in the face of evidence to the contrary. The way venture capitalists invest in start-ups—by providing capital in multiple rounds as the value of the venture increases—is far more effective. The competitive advantage of autonomous start-ups is that they have too little money to go far in the wrong direction.

We can demonstrate the power of this dynamic with two very different examples. Vermeer Technologies, a start-up based in Cambridge, Massachusetts, had only one product: a website development tool called FrontPage.