Does Off-Pump Coronary Surgery Reduce Morbidity and Mortality? A Review of the Recent Literature

By reviewing the recent literature, determine if off-pump myocardial revascularization reduces operative morbidity and mortality. Five recent reports comparing on-pump to off-pump coronary artery bypass surgery are summarized. Three of the studies are relatively large, retrospective clinical studies, and two are smaller, prospective randomized studies. In the three retrospective reports, different statistical techniques were used to reduce the effect selection bias has on outcome. In four of the five studies, off-pump myocardial revascularization reduced operative risk. In one of the prospective randomized studies, off-pump revascularization resulted in equivalent outcomes to on-pump surgery. In the reports demonstrating a beneficial effect of off-pump surgery, there were different degrees of benefit. Two of the studies reported a significant benefit of off-pump surgery, with decreased operative mortality and morbidity, and in two of the studies a more modest benefit was identified, with decreased morbidity and equivalent mortality. Off-pump coronary artery bypass surgery decreases the operative risk of coronary artery bypass surgery. However, to what degree is debatable.