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Updated: Jul 16, 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
Impact of off-pump coronary artery bypass surgery on graft patency: current best available evidence
Shahzad G Raja1, Gilles D Dreyfus
1Department of Cardiac Surgery, Royal Hospital for Sick Children, Glasgow, UK. drrajashahzad@hotmail.com
Insights
Off-pump coronary artery bypass surgery (OPCAB) avoids cardiopulmonary bypass (CPB) complications. This review evaluates randomized controlled trials on OPCAB
Area of Science:
- Cardiovascular Surgery
- Surgical Innovation
Background:
- Cardiopulmonary bypass (CPB) has been standard for coronary artery bypass surgery for over 30 years.
- CPB is associated with patient sequelae, including blood trauma, inflammation, non-pulsatile flow, and embolization.
- Off-pump coronary artery bypass (OPCAB) surgery has emerged as an alternative to mitigate CPB's adverse effects.
Purpose of the Study:
- To review the current evidence from prospective randomized controlled trials (RCTs).
- To evaluate the impact of OPCAB surgery on graft patency rates.
- To address concerns regarding anastomosis quality and long-term graft performance after OPCAB.
Main Methods:
- Systematic review and evaluation of existing prospective randomized controlled trials (RCTs).
- Focus on studies comparing OPCAB surgery with conventional on-pump procedures.
- Analysis of data specifically related to coronary artery graft patency.
Main Results:
- Evidence from RCTs is being analyzed to determine the comparative effectiveness of OPCAB.
- Results will elucidate graft patency rates in OPCAB versus conventional CPB surgery.
- The review aims to provide clarity on the quality and durability of anastomoses in OPCAB.
Conclusions:
- The study will synthesize evidence from RCTs to inform clinical practice regarding OPCAB.
- Findings will address the critical issue of graft patency in off-pump coronary artery bypass surgery.
- This review contributes to evidence-based decision-making for coronary revascularization strategies.
Abstract:
For more than three decades cardiac surgeons have been used to perform delicate coronary anastomoses on cardiopulmonary bypass (CPB). However, the price of a still and bloodless field is ultimately paid by the patients in the form of sequelae of negative effects of CPB including blood trauma, activation of a series of inflammatory responses, nonpulsatile flow, and possible embolization of air or debris. In an attempt to avoid these deleterious effects of CPB, off-pump coronary artery bypass surgery (OPCAB) has been rediscovered and refined. Although abundant evidence is available to suggest that excellent results can be achieved when CPB is avoided, concerns have been raised about quality of anastomosis and graft patency rates after OPCAB surgery. We are currently practicing in an era of evidence-based medicine that mandates the prospective randomized controlled trial (RCT) as the most accurate tool for determining a treatment benefit compared with a control population. This review article attempts to evaluate the current best available evidence from RCTs on the impact of OPCAB surgery on graft patency.
