title: Current randomized control trials, observational studies and meta analysis in off-pump coronary surgery.
abstract: The off-pump literature is divided into three eras: the "early phase" with results favouring off-pump surgery supported with randomized control trials (RCTs) mainly from Bristol, UK; an "intermediate phase" dominated by the results of the ROOBY trial and finally a more "contemporary phase" whereby the off/on-pump argument is unsettled. Although the literature has failed to project an overall superiority of off-pump versus on-pump surgery, nevertheless, small randomized control trials and large meta-analysis studies are concluding that the incidence of a stroke is less than 1 % when an aortic off-pump techniques (especially the non-touch technique) are advocated in patients with diseased ascending aorta. Furthermore, off-pump combined 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.The current review attempts to bring an insight onto the last ten years knowledge on the on/off-pump debate, with an aim to draw some clear conclusions in order to allow practitioners to reflect on the subject.
authors.affiliation: Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland. hparissis@yahoo.co.uk.
authors.forename: Haralabos
authors.initials: H
authors.lastname: Parissis
authors.affiliation: Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland.
authors.forename: Man Chi
authors.initials: MC
authors.lastname: Lau
authors.affiliation: Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland.
authors.forename: Mondrian
authors.initials: M
authors.lastname: Parissis
authors.affiliation: Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland.
authors.forename: Savvas
authors.initials: S
authors.lastname: Lampridis
authors.affiliation: Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland. vgraham87@gmail.com.
authors.forename: Victoria
authors.initials: V
authors.lastname: Graham
authors.affiliation: Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland. rezaalsaudi@rcsi.ie.
authors.forename: Reza
authors.initials: R
authors.lastname: Al-Saudi
authors.affiliation: Cardiothoracic Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK & Northern Ireland.
authors.forename: Peter
authors.initials: P
authors.lastname: Mhandu
mesh_terms: D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D015201:Meta-Analysis as Topic; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic