Current Status of Off-Pump Coronary-Artery Bypass

Until the mid-1990s, coronary-artery bypass grafting (CABG) was performed with the use of cardiopulmonary bypass with the induction of ischemic cardiac arrest (on-pump). This surgical approach provided excellent exposure in a bloodless field with an arrested heart, allowing for precise performance of coronary anastomoses.1 However, there was concern about potentially deleterious effects of cardiopulmonary bypass. Such effects include the induction of the systemic inflammatory response syndrome by the bypass circuit with consequent multiorgan injury and the risk of stroke or other systemic embolic events caused by the cross-clamping of the aorta. For these reasons, some surgeons began performing CABG procedures . . .