Off-pump coronary artery bypass graft surgery: where should we stand?
Coronary artery bypass grafting (CABG) performed with cardiopulmonary bypass has become a well-established treatment modality for patients with coronary artery disease. However, there is increasing evidence that cardiopulmonary bypass may be responsible for some of the morbidity associated with CABG surgery. Thus, it has been proposed that CABG surgery would be safer if cardiopulmonary bypass could be avoided. The development of cardiac stabilization devices has allowed for the creation of safe and reproducible coronary anastomoses on the beating heart. Several large, non-randomized, retrospective case series have demonstrated that CABG surgery can be performed safely without cardiopulmonary bypass (off-pump) and have in fact suggested benefits when compared with conventional CABG. However, the randomized controlled studies published to date have, as a whole, been unable to conclusively demonstrate the advantages of off-pump surgery. Taken together, the evidence to date suggests that a large-scale, prospective, randomized trial may be required to resolve the dilemma.
Légaré
Jean-Francois
JF
Division of Cardiovascular Surgery, New Halifax Infirmary, QEII HSC, Halifax, Nova Scotia, B3H 3A7, Canada. jean.legare@cdha.nshealth.ca
D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D006801:Humans