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Updated: Aug 11, 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
[Off-pump coronary artery bypass grafting in Japan]
1Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Japan.
Insights
Off-pump coronary artery bypass grafting (OPCAB) is increasingly the standard in Japan, with 60% of procedures performed without cardiopulmonary bypass. Arterial grafts are favored for better outcomes, especially in OPCAB surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Interventional Cardiology
Context:
- Coronary artery bypass grafting (CABG) in Japan exceeds 20,000 procedures annually with decreasing mortality.
- High-risk patients with specific comorbidities face elevated risks with traditional cardiopulmonary bypass.
- Minimally invasive techniques like off-pump coronary artery bypass grafting (OPCAB) have evolved.
Purpose:
- To describe the evolution and current trends of coronary artery bypass grafting (CABG) in Japan.
- To highlight the increasing adoption of off-pump coronary artery bypass grafting (OPCAB) and arterial grafts.
- To discuss the factors influencing the shift towards OPCAB and arterial revascularization.
Summary:
- Off-pump coronary artery bypass grafting (OPCAB) has become prevalent in Japan, accounting for 60% of CABG procedures in 2004, performed without cardiopulmonary bypass.
- The use of arterial grafts, particularly in OPCAB, is rising due to improved long-term outcomes, with 52% of total CABG and 66% of OPCAB cases utilizing arterial grafts alone.
- Minimally invasive direct coronary bypass, though less common, was an earlier approach for high-risk patients.
Impact:
- Off-pump coronary artery bypass grafting (OPCAB) is emerging as the standard surgical approach for coronary artery disease in Japan.
- The trend towards arterial grafts in CABG, especially OPCAB, suggests a focus on enhancing long-term patient outcomes.
- Competition from percutaneous coronary interventions with drug-eluting stents may also influence the preference for arterial grafts in CABG.
Abstract:
The number of coronary artery bypass grafting (CABG) procedures has reached more than 20,000 per year in Japan, and the operative mortality rate has decreased to less than 1.5% including emergent surgery. The mortality and morbidity rates of CABG are still high in patients with risk factors such as cerebrovascular disease, chronic renal failure on hemodialysis, atheromatous and calcified ascending aorta, and older age when cardiopulmonary bypass is used. Minimally invasive direct coronary bypass on a beating heart through a small left lateral anterior thoracotomy, in which the left internal thoracic artery (LITA) is used to revascularize the left anterior descending artery, was introduced for high-risk patients with single-vessel disease in the mid-1990s, although is not widely performed at present. Since the late 1990s off-pump coronary artery bypass grafting (OPCAB) has been widely performed as a treatment for multivessel disease through a median sternotomy with the evolution of stabilizers and apical suction devices, refined anesthetic management, and sophisticated surgical techniques. In 2004, 60% of all CABG procedures in Japan were performed without cardiopulmonary bypass. Due to competition from percutaneous coronary intervention with drug-eluting stents and better long-term outcomes, CABG with arterial grafts alone was carried out in 52% of total cases and in 66% of OPCAB cases. OPCAB is becoming the standard CABG in Japan.
