April 1, 2017Annals of Cardiac Anaesthesia11 citationsOpen Access
Myocardial Revascularization without Extracorporeal Circulation; Why Hasn’t It Convinced Yet?
Structured PICO
Does off-pump coronary artery bypass grafting improve clinical outcomes compared to on-pump coronary artery bypass grafting in patients requiring surgical revascularization?
P
Population
Patients requiring surgical myocardial revascularization
I
Intervention
Off-pump coronary artery bypass grafting (OPCAB)
C
Comparator
On-pump coronary artery bypass grafting (ONCAB) with cardiopulmonary bypass
O
Outcome
Clinical outcomes including mortality, graft patency, completeness of revascularization, complications, cost, and quality of life
Off-pump CABG remains technically challenging and does not offer superior long-term outcomes compared to the gold-standard on-pump CABG, though it may benefit specific high-risk patient subgroups.
Abstract
Extracorporeal circulation has led to a great development in cardiovascular surgery during the last five decades. Its time-proven efficacy and safety have made on-pump coronary artery bypass grafting (CABG) the gold standard method of surgical revascularization. However, coronary revascularization on cardiopulmonary bypass and the accompanying aortic manipulation are related to plenty of deleterious complications. Therefore, off-pump CABG surgery was established to avoid complications. Nevertheless, despite the initial enthusiasm on this technique, only 20% of myocardial revascularization procedures worldwide are performed off-pump. Not only are off-pump cardiac procedures more technically difficult but also they do not provide better results in terms of graft patency, completeness of revascularization, repeat revascularization requirement, cost, and quality of life. Completeness of revascularization and anastomotic quality should not be compromised to avoid cardiopulmonary bypass.