Pump or no pump for coronary artery bypass: current best available evidence

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.