title: Off-pump coronary surgery: current justifications.
abstract: Although the literature has failed to project an overall superiority of off-pump vs. on-pump surgery, nevertheless, small randomized control trials and large meta-analysis studies have concluded that the incidence of a stroke is less than 1 % when anaortic off-pump techniques are advocated in patients with diseased ascending aorta. Furthermore, off-pump techniques or their combination with hybrid procedures may lead to a reduction of adverse outcome in the aged high-risk population with concomitant poor left ventricular function and co-morbidities. However, despite this, controversy still exists among the cardiac surgery community in terms of the benefit of this technique and its safety; hence, off-pump is becoming out of fashion. In this review paper, by looking at a "marginal group of patients" (elderly, high risks, atherosclerotic aortas) we attempt to re-establish and justify this technique and re-invent its usage.
authors.affiliation: Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK, hparissis@yahoo.co.uk.
authors.forename: Haralabos
authors.initials: H
authors.lastname: Parissis
authors.forename: B C
authors.initials: BC
authors.lastname: Ramesh
authors.forename: Bassel
authors.initials: B
authors.lastname: Al-Alao
mesh_terms: D000367:Age Factors; D001011:Aorta / Q000601:surgery; D001281:Atrial Fibrillation / Q000209:etiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D015897:Comorbidity; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000209:etiology