Off-pump coronary artery bypass: past, present and future of a controversial technology.
OBJECTIVE
This review will examine the current role of off-pump coronary artery bypass (OPCAB) surgery compared with on-pump coronary artery bypass (ONCAB) surgery for the revascularization of ischemic myocardium.


RESULTS
Recent studies have confirmed earlier findings that OPCAB is associated with less grafts per patient and less complete revascularization, and increased incidence of recurrent angina and need for repeat revascularization procedures, and more frequent rehospitalization for cardiac-related issues. OPCAB does not prevent postoperative renal dysfunction and is associated with worse long-term outcomes. Hospital costs are not reduced and are increased in those OPCAB patients who require intraoperative conversion to ONCAB procedures; however, when multiple arterial grafts are used and a complete revascularization is performed, OPCAB outcomes are equivalent to those of ONCAB procedures.


CONCLUSIONS
OPCAB should only be performed by surgeons experienced in this technique in patients in whom a complete revascularization can be achieved; preferably with multiple arterial grafts.
Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Harold L
HL
Lazar
D001026:Coronary Artery Bypass / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods* / Q000639:trends*; D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans