title: Impact of off-pump coronary artery bypass grafting on survival: current best available evidence.
abstract: The superiority of either off-pump (OPCAB) or on-pump (ONCAB) coronary artery bypass grafting (CABG) remains unclear despite a large body of literature evidence comparing the two approaches. The potential advantages of avoiding cardiopulmonary bypass (CPB), minimizing aortic manipulation and maintaining pulsatile flow may be associated with reduced inflammatory responses and embolic events. Numerous studies compared OPCAB with ONCAB and the cumulative data have been presented in meta-analyses of both randomized and observational studies. Although there is an abundance of data with respect to the operative morbidity and mortality and the short-term outcomes associated with these two strategies, not much is known about how they impact long-term survival and recurrence of myocardial ischaemic events. Recent studies and meta-analyses have focused on long-term survival and major secondary outcomes in OPCABvs.ONCAB within the general population. Significant limitations in methodology, however, have raised concerns about the strength of several randomized trials with restrictive inclusion criteria that reduced the populations to those at low risk only, thus creating result bias. Here, we present a review of the best available evidence with a focus on long-term outcomes.
authors.affiliation: Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Chivasso
authors.affiliation: Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK.
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Guida
authors.affiliation: Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Fudulu
authors.affiliation: Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK.
authors.forename: Vito D
authors.initials: VD
authors.lastname: Bruno
authors.affiliation: Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK.
authors.forename: Roberto
authors.initials: R
authors.lastname: Marsico
authors.affiliation: Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK.
authors.forename: Hristo
authors.initials: H
authors.lastname: Sedmakov
authors.affiliation: Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Zakkar
authors.affiliation: Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK.
authors.forename: Filippo
authors.initials: F
authors.lastname: Rapetto
authors.affiliation: Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Bryan
authors.affiliation: Bristol Heart Institute, Bristol University, Upper Maudlin Street, BS2 8HW, Bristol, UK.
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
keywords: Off-pump coronary artery bypass surgery (OPCAB); coronary artery bypass grafting (CABG); coronary by-pass grafting; long term; off-pump; review