The current status of off-pump coronary bypass surgery

Coronary artery disease is the leading cause of the death in the Western world. Almost 500 000 coronary artery bypass (CABG) surgeries are performed in the USA annually. In the last 20 years, interest has increased in performing CABG without the use of cardiopulmonary bypass (CPB), to reduce postoperative complications associated with the use of CPB and aortic manipulation. Still, only about 20% of all CABG surgeries are performed off-pump and it is still debatable whether off-pump CABG has decreased postoperative morbidity and mortality compared to conventional CABG surgery.

Off-pump CABG is associated with less blood loss and need for transfusion, less postoperative atrial fibrillation, less stroke and probably less renal dysfunction. It is also associated with shorter postoperative intubation time and hospital length of stay. However, conventional CABG is associated with more complete revascularization and better graft patency rate.

Both off-pump and on-pump CABG have an excellent safety profile with very low morbidity and mortality. It seems that off-pump CABG is associated with reduced short-term postoperative morbidity; however, graft patency rate is higher and long-term mortality may be lower after on-pump CABG. Patient selection criteria and surgical skills are at least as important as the decision about the surgical technique.