Pump or no pump for coronary artery bypass: current best available evidence
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Updated: Aug 13, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
1Department of Cardiac Surgery, Royal Hospital for Sick Children, Glasgow G3 8SJ, United Kingdom. drrajashahzad@hotmail.com
Insights
Off-pump coronary artery bypass surgery may offer better outcomes than traditional on-pump surgery. This review evaluates clinical trial evidence on the safety and efficacy of off-pump coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Coronary artery bypass grafting (CABG) traditionally uses cardiopulmonary bypass (CPB) and cardioplegic arrest.
- CPB is associated with numerous complications, prompting interest in alternative techniques.
- Off-pump coronary artery bypass (OPCAB) surgery aims to reduce complications and improve patient outcomes.
Purpose of the Study:
- To evaluate the best available clinical trial evidence on the safety and efficacy of OPCAB surgery.
- To address existing skepticism regarding OPCAB's safety and effectiveness.
Main Methods:
- Review of existing world medical literature.
- Focus on evidence from randomized clinical trials, nonrandomized clinical trials, propensity-matched analyses, and experimental data.
- Prioritization of randomized clinical trial results in the era of evidence-based medicine.
Main Results:
- A significant body of research suggests better outcomes with OPCAB compared to on-pump CABG.
- Evidence includes data from numerous clinical trials and analyses.
- Skepticism regarding OPCAB's safety and efficacy persists despite available data.
Conclusions:
- The review critically assesses clinical trial evidence to determine the safety and efficacy of OPCAB.
- Evidence-based medicine principles guide the evaluation of OPCAB versus on-pump CABG.
- Further clarification on OPCAB's benefits and risks is sought through rigorous review of trial data.
Abstract:
Coronary artery bypass grafting has been performed predominantly with the use of cardiopulmonary bypass and cardioplegic arrest, which allows optimization of the surgical field and consistent placement of grafts. However, the use of cardiopulmonary bypass is also associated with numerous complications. A surgical technique avoiding cardiopulmonary bypass should, in theory, reduce the incidence of such complications and lead to improved patient outcomes. This assumption has rekindled interest in performing off-pump coronary artery bypass surgery, which is currently the focus of scientific scrutiny. The existing world medical literature contains a staggering amount of research related to this technique. Although the available evidence from a large number of randomized clinical trials, nonrandomized clinical trials, propensity-matched analyses, and experimental data suggests that outcomes are better after off-pump than after on-pump coronary artery bypass surgery, skepticism still exists about the safety and efficacy of the off-pump technique. In the present era of evidence-based medicine, results from randomized clinical trials are given the highest recognition. This review attempts to evaluate the best currently available evidence from clinical trials about the safety and efficacy of off-pump coronary artery bypass surgery.
