Off-pump coronary artery bypass surgery remains controversial compared to on-pump surgery, with ongoing debate over its clinical and angiographic outcomes despite evidence from 115 randomized trials.
Does off-pump coronary artery bypass surgery (OPCAB) improve clinical outcomes compared to on-pump coronary artery bypass surgery (ONCAB) in patients requiring surgical revascularization?
Despite over 30 years of debate and numerous trials, the optimal role and indications for off-pump versus on-pump CABG remain controversial, with trade-offs between early perioperative benefits and concerns about long-term revascularization quality.
Off‐pump coronary artery bypass surgery (OPCAB) has been performed for >30 years. The promotion of OPCAB was based on its potential benefits over some of the limitations of traditional on‐pump coronary artery bypass surgery (ONCAB) by avoiding the trauma of cardiopulmonary bypass (CPB) and by minimizing aortic manipulation. As such, reductions in early mortality and perioperative neurological events, renal failure, blood product transfusions, and hospital length of stay were expected according to the OPCAB proponents. In contrast, critics of OPCAB remain concerned about incomplete and/or poorer quality coronary revascularization with a potential increase in the need for repeat revascularization and late mortality. Despite 3 decades of debate, 115 randomized trials, and >60 meta‐analyses comparing on‐ and off‐pump coronary artery bypass grafting (CABG), controversy on both the role of and indications for OPCAB remains vigorous. In this review, we provide a comprehensive update of the evidence for the differences in the biological effects of off‐ and on‐pump surgery and the comparison of the clinical and angiographic results of the 2 techniques. Furthermore, we critically address the relevant technical aspects of OPCAB, the importance of surgeon experience, and the difference in the costs for the 2 procedures.
Gaudino et al. (Tue,) conducted a review in Coronary artery disease. Off-pump coronary artery bypass surgery (OPCAB) vs. On-pump coronary artery bypass surgery (ONCAB) was evaluated. Off-pump coronary artery bypass surgery remains controversial compared to on-pump surgery, with ongoing debate over its clinical and angiographic outcomes despite evidence from 115 randomized trials.