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Two decades of off-pump coronary artery bypass surgery: Harefield experience
1Department of Cardiac Surgery, Harefield Hospital, London, UK.
Insights
Off-pump coronary artery bypass (OPCAB) surgery has become a safe and effective alternative to conventional methods, reducing risks associated with cardiopulmonary bypass. Experienced surgeons can achieve complete myocardial revascularization in most patients with multivessel coronary artery disease using OPCAB.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Conventional coronary artery bypass grafting (CABG) involves cardiopulmonary bypass (CPB), which is associated with significant morbidity and mortality.
- Off-pump coronary artery bypass (OPCAB) surgery emerged as an alternative to mitigate CPB-related complications.
- Harefield hospital adopted OPCAB surgery to drive innovation and improve patient outcomes.
Approach:
- This review examines the evolution and institutional adoption of OPCAB surgery.
- The article highlights the progression from a challenging technique to a standard procedure.
- It details the systematic application of OPCAB for complete myocardial revascularization across diverse coronary anatomies.
Key Points:
- OPCAB surgery has become the preferred method for over 50% of coronary artery surgeries at Harefield hospital.
- The technique allows for complete revascularization of all coronary territories.
- Equivalent graft quality is achieved without restrictions on vascular conduit usage.
Conclusions:
- Mature surgical experience with OPCAB enables safe and effective total myocardial revascularization.
- OPCAB is a viable substitute for conventional CABG in patients with multivessel coronary artery disease.
- The institutional program demonstrates the successful long-term integration of OPCAB surgery.
Abstract:
The morbidity and mortality associated with conventional coronary artery bypass grafting (CABG) attributed to invasiveness of cardiopulmonary bypass (CPB) has been well documented. Recognition of this invasiveness with a focus centered on abolishing, or at least reducing the CPB associated morbidity and mortality led to the resurgence of off-pump coronary artery bypass (OPCAB) surgery nearly two decades ago. At about the same time, OPCAB was adopted at Harefield hospital partly as an institutional drive to promote innovation and partly as a strategy to improve outcomes. What was deemed as a challenging technique initially and practiced by a single surgeon has now become a valid substitute to conventional CABG for achieving complete myocardial revascularization. This strategy now accounts for more than 50% of all coronary artery surgery operations at Harefield hospital and is systematically used to treat all coronary anatomies; achieve complete revascularization by accessing all territories subtended by main coronary arteries; and accomplish equivalent quality grafts without restriction in vascular conduit usage. This review article provides an overview of the evolution of OPCAB surgery at an institution with a well-established OPCAB program confirming that as surgeons' experience matures, OPCAB surgery permits safe and effective total myocardial revascularization in virtually all patients with multivessel coronary artery disease.