Off-Pump Versus On-Pump Coronary Artery Bypass Grafting—A Systematic Review and Analysis of Clinical Outcomes

Shahzad Shaefi, Aaron Mittel, Dan Loberman, Harish Ramakrishna

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Surgical coronary artery bypass grafting (CABG) is the standard of care for revascularization of left main or three-vessel coronary artery disease. The off-pump coronary artery bypass graft (OPCAB) procedure avoids the use of cardiopulmonary bypass. Theoretically, OPCAB may improve long-term outcomes by reducing the rates of perioperative myocardial injury, stroke, neurocognitive impairment, and cardiac-related mortality. Several high-quality clinical trials have been conducted since OPCAB became popular in the 1990s and have demonstrated no benefit of OPCAB over traditional CABG with respect to these outcomes despite favorable short-term reductions in transfusion requirements and other postoperative complications. Ultimately, OPCAB is associated with less effective myocardial revascularization and does not entirely prevent complications traditionally associated with cardiopulmonary bypass. This article reviews major high-quality trials of OPCAB versus traditional CABG with respect to both short- and long-term clinical outcomes.

Original languageEnglish (US)
JournalJournal of Cardiothoracic and Vascular Anesthesia
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Transplants
Cardiopulmonary Bypass
Myocardial Revascularization
Standard of Care
Coronary Artery Disease
Stroke
Clinical Trials
Mortality
Wounds and Injuries

Keywords

  • cardiopulmonary bypass
  • coronary artery bypass grafting
  • coronary artery graft patency
  • off-pump coronary artery bypass grafting
  • surgical revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

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abstract = "Surgical coronary artery bypass grafting (CABG) is the standard of care for revascularization of left main or three-vessel coronary artery disease. The off-pump coronary artery bypass graft (OPCAB) procedure avoids the use of cardiopulmonary bypass. Theoretically, OPCAB may improve long-term outcomes by reducing the rates of perioperative myocardial injury, stroke, neurocognitive impairment, and cardiac-related mortality. Several high-quality clinical trials have been conducted since OPCAB became popular in the 1990s and have demonstrated no benefit of OPCAB over traditional CABG with respect to these outcomes despite favorable short-term reductions in transfusion requirements and other postoperative complications. Ultimately, OPCAB is associated with less effective myocardial revascularization and does not entirely prevent complications traditionally associated with cardiopulmonary bypass. This article reviews major high-quality trials of OPCAB versus traditional CABG with respect to both short- and long-term clinical outcomes.",
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AU - Shaefi, Shahzad

AU - Mittel, Aaron

AU - Loberman, Dan

AU - Ramakrishna, Harish

PY - 2018/1/1

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