title: Is the evidence from first time off-pump coronary artery bypass graft surgery transferable to re-operative off-pump surgery?
abstract: On-pump coronary artery surgery remains the gold standard treatment for multi-vessel disease. The technique of off-pump surgery has evolved since its first use; however, currently less than 20% of all cases worldwide are performed this way. This poor uptake has been both the cause and the effect of widespread scepticism regarding the validity of the data on the technique, as well as criticism regarding the conversion-related adverse outcomes, graft patency and completeness of revascularisation. Consequently, there has been focus on patient selection from subgroups most likely to benefit from the technique. Re-operative patients, by virtue of their advanced age, complex co-morbidities and the technical challenges of re-operation, fall into this category. In this review, the authors will discuss the outcomes of off-pump surgery in comparison to on-pump, explore the potential beneficial effects of off-pump in re-operative surgery and formulate a decision-making strategy in patients undergoing reoperative coronary artery surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Imperial College London, London, UK.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Sepehripour
authors.forename: Amna
authors.initials: A
authors.lastname: Suliman
authors.forename: George
authors.initials: G
authors.lastname: Stavridis
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D018579:Patient Selection; D012086:Reoperation; D019737:Transplants; D016896:Treatment Outcome
keywords: cardio-pulmonary bypass; coronary artery bypass graft surgery; off-pump surgery; on-pump surgery; outcomes; re-operative surgery