Off-pump coronary artery bypass surgery reduces postoperative morbidity and mortality based on emerging evidence from randomized controlled trials and large registries.
Does off-pump coronary artery bypass (OPCAB) surgery reduce postoperative bleeding and transfusion requirements compared to surgery with cardiopulmonary bypass in patients undergoing myocardial revascularization?
This review evaluates the current best available evidence from RCTs on whether off-pump coronary artery bypass surgery reduces postoperative bleeding and transfusion requirements compared to on-pump surgery.
Cardiopulmonary bypass (CPB) is a prerequisite for open-heart surgery, and is a procedure routinely used. CPB exposes blood to artificial surfaces, to mechanical trauma from the pump, to alterations in temperature, and to dilution with fluids, whole blood, plasma products, and drugs, and leads to the activation of platelets, coagulation, and fibrinolysis. Coagulopathy during cardiac surgery with CPB results in impairment in hemostasis and subsequently higher morbidity and mortality. Recent advances in surgical techniques and postoperative management have aimed at reducing postoperative morbidity and mortality. Off-pump coronary artery bypass (OPCAB) surgery is one such advance that attempts to avoid the deleterious effects of extracorporeal circulation by performing myocardial revascularization without CPB. Emerging evidence from several randomized controlled trials (RCTs) as well as large registries such as the Society of Thoracic Surgeons (STS) database suggests that OPCAB reduces the postoperative morbidity and mortality. This review article attempts to evaluate the current best available evidence from RCTs on the impact of OPCAB on postoperative bleeding and transfusion requirements.
Raja et al. (Sun,) conducted a review in Coronary artery disease requiring bypass surgery. Off-pump coronary artery bypass (OPCAB) vs. Cardiopulmonary bypass (CPB) was evaluated on Postoperative bleeding and transfusion requirements. Off-pump coronary artery bypass surgery reduces postoperative morbidity and mortality based on emerging evidence from randomized controlled trials and large registries.