Current status of off-pump coronary artery bypass surgery.
The expanding indications for angioplasty coupled with the successful short and mid-term results of randomized controlled trials of drug-eluting stents have already had an unquestionable impact on the practice of coronary revascularization operations. However, coronary artery bypass grafting remains a major mode of therapy for coronary artery disease. It is likely that surgery will continue to be preferred for more complex subsets and that surgeons will have to continue to maintain good results in patients with more complex problems. Concerns regarding morbidity associated with conventional surgical myocardial revascularization on cardiopulmonary bypass have led to a resurgence of interest in off-pump bypass surgery during the last decade, with the expectation that it would be safer if cardiopulmonary bypass could be avoided. This review summarizes the impact of off-pump bypass surgery in reducing the morbidity and mortality associated with conventional coronary artery bypass on cardiopulmonary bypass by evaluating the current best-available evidence from randomized controlled trials and meta-analyses comparing off-pump surgery with conventional bypass grafting.
Raja
Shahzad G
SG
Glasgow Royal Infirmary, Department of Cardiac Surgery (Ward 65), Queen Elizabeth Building, Alexandra Parade, Glasgow, G31 2ER, Scotland. United Kingdom. drrajashahzad@hotmail.com
Dreyfus
Gilles D
GD
D001281:Atrial Fibrillation / Q000209:etiology; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000209:etiology; D002983:Clinical Competence; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019317:Evidence-Based Medicine; D005767:Gastrointestinal Diseases / Q000209:etiology; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D007249:Inflammation / Q000209:etiology; D007902:Length of Stay; D008171:Lung Diseases / Q000209:etiology; D018579:Patient Selection; D011788:Quality of Life; D051437:Renal Insufficiency / Q000209:etiology; D018570:Risk Assessment; D016896:Treatment Outcome; D014654:Vascular Patency