Current outcomes of off-pump coronary artery bypass grafting: evidence from real world practice

Abstract

Coronary artery bypass grafting (CABG) can be performed conventionally using cardiopulmonary bypass (CPB) and aortic clamping or on a beating heart (BH) without the use of CPB, the so-called off-pump CABG. Some surgeons, who are proponents of off-pump CABG, preferentially use this technique for the majority of operations, whereas others use it only in certain situations which warrant avoidance of CPB. Ever since the conception of off-pump CABG, the never-ending debate about which technique of CABG is safe and efficacious continues to date. Several randomized controlled trials (RCTs) have been conducted that have either favored on-pump CABG or have failed to show a significant difference in outcomes between the two techniques. However, these RCTs have been fraught with claims that they do not represent the majority of patients undergoing CABG in real world practice. Therefore, assessment of the benefits and drawbacks of each technique through observational and registry studies would be more representative of patients encountered in daily practice. The present review examines various retrospective studies and meta-analyses of observational studies that compare the early and long-term outcomes of off- and on-pump CABG, which assesses their safety and efficacy. Additionally, their outcomes in older patients, females, and those with diabetes mellitus, renal dysfunction, presence of ascending aortic disease, and/or acute coronary syndrome (ACS) have also been discussed separately. The general consensus is that early results of off-pump CABG are comparable to or in some cases better than on-pump CABG. However, on-pump CABG provides a survival benefit in the long term according to a majority of publications in literature.

The Asian system for cardiac operative risk evaluation for predicting mortality after isolated coronary artery bypass graft surgery (ASCORE‐C)

“…Our findings partially explained why EuroSCORE I/II and STS score may not be accurate enough for our population, with different Asian ethnic groups. Off‐pump techniques show slightly high mortality than on pump because it was only recommended to those high‐risk patients in our centre which is consistent to previous reports 31,32 . It did not increase mortality significantly or benefit patient in our patients.…”

Revascularization strategies in patients with multivessel coronary artery disease: a Bayesian network meta-analysis

“…OPCAB was developed to achieve revascularization without the use of cardiopulmonary bypass and aortic manipulation, thus theoretically reducing early complications that have been traditionally associated with ONCAB [ 15 ]. Initial observational studies have indeed shown benefits including reduced transfusion [ 16 ], renal dysfunction [ 17 ], postoperative atrial fibrillation [ 18 ] and risk of stroke [ 19 ]. However, a benefit of OPCAB has not been consistently shown in RCTs [ 20 , 21 ], possibly due to the large variations in centre and surgeon volume as well as higher frequencies of incomplete revascularization with OPCAB [ 21 ].…”

Complications and In-Hospital Mortality After On- Pump Vs Off-Pump Coronary Artery Bypass Grafting

“…et Off-pump surgery has evolved into the most frequently adopted alternative technique to conventional on-pump coronary artery bypass grafting (CABG) in the treatment of patients with coronary artery disease (CAD) over the last two decades [Davierwala, P. M. 2016].…”