Off-pump coronary artery bypass grafting through sternotomy: for whom?
OBJECTIVE
Off-pump coronary artery bypass grafting hopes to avoid morbidity associated with cardiopulmonary bypass, improving clinical outcomes. Yet its technical difficulty and unfamiliarity raise concern that adoption of off-pump coronary artery bypass might be associated with poorer outcomes. Both surgeon-specific and patient-related factors are believed to play roles in the success of off-pump coronary artery bypass. This review sought to elucidate these factors.


RESULTS
Current prospective data suggest that both techniques have similar rates of mortality but off-pump coronary artery bypass does provide patients with a lower morbidity. Multiple prospective studies suggest a decrease in stroke rates for off-pump coronary artery bypass grafting. There is a consensus that certain patients will have better outcomes if done off-pump. Surgeon experience with the procedure does impact patient outcome.


CONCLUSIONS
Though every patient must be dealt with on an individual basis, it would appear that almost any patient is a candidate for off-pump coronary artery bypass and that, given time and an appropriate desire, most any surgeon can perform the procedure.
Noora
Joseph
J
Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, GA, USA.
Puskas
John D
JD
D002983:Clinical Competence; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D018579:Patient Selection; D013249:Sternum / Q000601:surgery*; D013908:Thoracotomy; D016896:Treatment Outcome