Does multivessel, off-pump coronary artery bypass reduce postoperative morbidity?

Perioperative Advantages of Off-Pump Coronary Artery Bypass Grafting.

“…Previous studies of OPCAB have unanimously reported a decrease in bleeding. 6,[8][9][10] Blood transfusion impairs the function of the lungs and other organs, and may also cause ominous postoperative infections, such as HIV, hepatitis, and adult T cell leukemia. The shortening of the procedure time with OPCAB is also related to the smaller number of grafts, no time spent on cannulation, the incidence of cardiac arrest, and rewarming from the hypothermia during CPB.…”

“…[20][21][22] However, the risk of neurological complications and stroke still remains because partial aortic cross-clamping may cause atheromatous emboli, particularly in patients older than 70 years. 9 Murkin et al examined the extradural pressure via an intracranial catheter and associated cerebral embolization by transcranial Doppler during CPB and reported that fewer cerebral emboli, less cerebral venous hypertension, and better maintenance of the arterial pressure during OPCAB contributed to the lower incidence of neurologic complications. 21 Although maintaining the mean arterial pressure during OPCAB may reduce the incidence of neurologic complications, watershed infarction because of low blood pressure during manipulation of the heart is thought to be uncommon.…”

Is it time to adopt beating-heart coronary artery bypass grafting? A review of literature

“…In a prospective non-randomized cohort study, Casati et al [13] demonstrated significantly higher antithrombin and plasminogen concentrations and reduced D-dimer formation (fibrinolysis) in patients undergoing off-compared to on-pump CABG. Randomized trials, matched cohort and retrospective studies [16][17][18][19] consistently demonstrate reduced blood loss, re-operation for bleeding and requirements for allogenic blood products in OPCAB than in on-pump patients. Ascione et al [8], in their study shows that transfusion requirements were higher in the on-pump group, and this reflected the significantly higher mean transfusion costs, re-entry for bleeding occurred infrequently in the OPCAB group.…”

Hospital and Mid-Term Outcomes in Elderly Patients Under-going Off-Pump Coronary Artery Bypass Grafting-Comparison With Younger Patients-

“…It has been reported that the elimination of CPB reduces the amount of blood loss and the need for blood transfusion. 6,[18][19][20] However, there was a high rate of blood transfusion in the elderly patients in this study, which may be related to the lower preoperative hemoglobin concentration (12.1 mg/dl elderly vs 13.1 mg/dl younger, p=0.0006) and smaller body surface area (1.5 m 2 elderly vs 1.6 m 2 younger, p=0.001) of the elderly patients.…”