Off-pump coronary artery bypass grafting: 30 years of debate

Mario Gaudino*, Gianni D. Angelini, Charalambos Antoniades, Faisal Bakaeen, Umberto Benedetto, Antonio M. Calafiore, Antonino Di Franco, Michele Di Mauro, Stephen E. Fremes, Leonard N. Girardi, David Glineur, Juan Grau, Guo Wei He, Carlo Patrono, John D. Puskas, Marc Ruel, Thomas A. Schwann, Derrick Y. Tam, James Tatoulis, Robert TranbaughMichael Vallely, Marco A. Zenati, Michael Mack, David P. Taggart

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)

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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.
Original languageEnglish
Article numbere009934
Number of pages15
JournalJournal of the American Heart Association
Volume7
Issue number16
Early online date14 Aug 2018
DOIs
Publication statusPublished - 21 Aug 2018

Structured keywords

  • Centre for Surgical Research

Keywords

  • Coronary artery bypass grafting
  • Off-pump
  • Off-pump coronary artery bypass

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    Gaudino, M., Angelini, G. D., Antoniades, C., Bakaeen, F., Benedetto, U., Calafiore, A. M., Franco, A. D., Mauro, M. D., Fremes, S. E., Girardi, L. N., Glineur, D., Grau, J., He, G. W., Patrono, C., Puskas, J. D., Ruel, M., Schwann, T. A., Tam, D. Y., Tatoulis, J., ... Taggart, D. P. (2018). Off-pump coronary artery bypass grafting: 30 years of debate. Journal of the American Heart Association, 7(16), [e009934]. https://doi.org/10.1161/JAHA.118.009934