151. Off-Pump Coronary Artery Bypass Grafting: 30 Years of Debate
- Author
-
Gianni D Angelini, Robert F. Tranbaugh, Michael P. Vallely, Umberto Benedetto, James Tatoulis, Marc Ruel, Antonio M. Calafiore, Faisal G. Bakaeen, Michael J. Mack, Mario Gaudino, David P. Taggart, Stephen E. Fremes, Guo-Wei He, Charalambos Antoniades, Leonard N. Girardi, Juan B. Grau, Michele Di Mauro, David Glineur, Derrick Y. Tam, Carlo Patrono, Antonino Di Franco, Marco A. Zenati, Thomas A. Schwann, and John D. Puskas
- Subjects
medicine.medical_specialty ,Bypass grafting ,medicine.medical_treatment ,Coronary Artery Bypass, Off-Pump ,coronary artery bypass grafting ,Coronary artery bypass grafting ,Off-pump ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,Coronary artery bypass surgery ,off‐pump ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Contemporary Review ,medicine ,Cardiopulmonary bypass ,Humans ,Coronary Artery Bypass ,Blood Coagulation ,Off-pump coronary artery bypass ,Inflammation ,Cardiopulmonary Bypass ,Cardiovascular Surgery ,business.industry ,Revascularization ,Perioperative ,Health Care Costs ,Platelet Activation ,Coronary revascularization ,medicine.anatomical_structure ,Treatment Outcome ,030228 respiratory system ,Centre for Surgical Research ,Cardiology ,off‐pump coronary artery bypass ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
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.
- Published
- 2018