title: Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials.
abstract: Coronary artery bypass grafting remains the standard treatment for patients with extensive coronary artery disease. Coronary surgery without use of cardiopulmonary bypass avoids the deleterious systemic inflammatory effects of the extracorporeal circuit. However there is an ongoing debate surrounding the clinical outcomes after on-pump versus off-pump coronary artery bypass (ONCAB versus OPCAB) surgery. The current review is based on evidence from randomized controlled trials (RCTs) and meta-analyses of randomized studies. It focuses on operative mortality, mid- and long-term survival, graft patency, completeness of revascularisation, neurologic and neurophysiologic outcomes, perioperative complications and outcomes in the high risk groups. Early and late survival rates for both OPCAB and ONCAB grafting are similar. Some studies suggest early poorer vein graft patency with off-pump when compared with on-pump, comparable midterm arterial conduit patency with no difference in long term venous and arterial graft patency. A recent, pooled analysis of randomised trials shows a reduction in stroke rates with use off-pump techniques. Furthermore, OPCAB grafting seems to reduce postoperative renal dysfunction, bleeding, transfusion requirement and respiratory complications while perioperative myocardial infarction rates are similar to ONCAB grafting. The high risk patient groups seem to benefit from off-pump coronary surgery.
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol, Bristol, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Fudulu
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol, Bristol, UK.
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol, Bristol, UK.
authors.forename: Gustavo Guida
authors.initials: GG
authors.lastname: Pecchinenda
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol, Bristol, UK.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Chivasso
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol, Bristol, UK.
authors.forename: Vito Domenico
authors.initials: VD
authors.lastname: Bruno
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol, Bristol, UK.
authors.forename: Filippo
authors.initials: F
authors.lastname: Rapetto
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol, Bristol, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Bryan
authors.affiliation: Bristol Heart Institute, University Hospitals Bristol, Bristol, UK.
authors.forename: Gianni Davide
authors.initials: GD
authors.lastname: Angelini
keywords: Coronary artery bypass; beating heart coronary artery bypass; evidence; off-pump coronary artery bypass (OPCAB); outcome measure; randomized controlled trial (RCT)