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Updated: Sep 28, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Is 100% beating heart coronary by-pass justified?
Saba Davit1, Isik Senkaya, Abdül Kadir Ercan
1Uludağ University Medical Faculty, Department of Thoracic and Cardiovascular Surgery, Görükle, 16059, Bursa, Turkey. davids@uludag.edu.tr
Insights
Off-pump coronary artery bypass surgery on a beating heart is a safe and effective alternative to traditional bypass. This technique reduces complications like bleeding and hospital stay, offering comparable outcomes for patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) traditionally uses cardiopulmonary bypass (CPB), which carries known side effects.
- Off-pump coronary artery bypass (OPCAB) surgery, performed on a beating heart, avoids CPB and may be safer, particularly for high-risk individuals.
Purpose of the Study:
- To evaluate the feasibility and outcomes of multivessel off-pump coronary artery bypass surgery in all referred patients.
- To compare OPCAB surgery with conventional on-pump CABG in terms of safety and efficacy.
Main Methods:
- A prospective study of 294 patients undergoing OPCAB surgery.
- Comparison with a control group of 100 patients who underwent conventional on-pump CABG.
- Analysis of preoperative risk factors and postoperative outcomes including complications, blood loss, and hospital stay.
Main Results:
- OPCAB patients showed significantly lower requirements for inotropes, lower peak creatine phosphokinase-MB levels, shorter ventilation times, less blood loss, fewer transfusions, reduced incidence of new-onset atrial fibrillation, and shorter hospital stays.
- No significant differences were observed in neurological complications, chest infections, intra-aortic balloon pump usage, or mortality between the groups.
- Higher incidence of peripheral vascular disease in the OPCAB group and higher rates of chronic obstructive pulmonary disease and lower ejection fraction in the conventional group were noted.
Conclusions:
- Multivessel off-pump coronary artery bypass surgery is feasible and demonstrates comparable or superior results to the conventional on-pump technique.
- OPCAB surgery offers advantages in reducing postoperative bleeding, neurogenic complications, arrhythmias, and hospital stay, with similar overall morbidity and mortality.
- Off-pump surgery is a viable and potentially safer revascularization strategy, especially for high-risk patients.
Abstract:
Coronary by-pass on a beating heart may provide a safer form of surgical revascularization by avoiding the well-documented side effects of cardiopulmonary by-pass. In addition, off-pump bypass is suggested to be a good alternative to on-pump especially in high risk patients. This study reviews the feasibility of coronary by-pass on the beating heart in all patients referred to surgery. Two hundred and ninety-four patients operated on the beating heart were prospectively followed and compared to the control group of 100 consecutive patients operated with the conventional method. There were no significant differences between the groups with respect to risk factors, except the incidence of chronic obstructive pulmonary disease and ejection fraction which were higher in the conventional group, whereas peripheral vascular disease was higher in the beating heart group. There was more distal anastomosis in the conventional group. Postoperative inotrope requirement, peak creatine phosphokinase- MB, ventilation time, blood loss in the first 24 h, transfusion needs, new atrial fibrillation and length of hospital stay were significantly lower in the beating heart operations. However, there were no significant differences between the groups in terms of neurological complications, chest infection, intraaortic balloon pump usage and mortality. In conclusion, multivessel off pump coronary by-pass is feasible with the same or better results as it is observed in the conventional technique when postoperative bleeding, neurogenic complications, arrythmias, hospital stay, overall morbidity and mortality are compared.
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