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Updated: Dec 15, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
On-pump beating-heart coronary artery bypass grafting in high-risk patients: A systematic review and meta-analysis
Carmelo Dominici1, Antonio Salsano2, Antonio Nenna1
1Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
Insights
On-pump beating-heart coronary artery bypass graft (OPBHC) surgery in high-risk patients reduces early mortality and stroke compared to traditional on-pump CABG. This hybrid approach offers an effective alternative for select patient populations.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Surgical myocardial revascularization in high-risk patients is debated.
- On-pump coronary artery bypass graft (CABG) and off-pump CABG have limitations.
- On-pump beating-heart CABG (OPBHC) is a hybrid approach with conflicting results.
Purpose of the Study:
- To systematically review and meta-analyze contemporary literature on OPBHC.
- To compare OPBHC with on-pump CABG and off-pump CABG.
- To evaluate the effectiveness and safety of OPBHC in high-risk patients.
Main Methods:
- Systematic literature search of major electronic databases.
- Inclusion of 17 studies from 279 initially identified articles.
- Meta-analysis of comparative outcomes.
Main Results:
- OPBHC patients had higher preoperative risk but reduced early mortality (RR 0.59) and stroke (RR 0.60) versus on-pump CABG.
- Trends towards reduced use of intra-aortic balloon pump (RR 0.56) and myocardial infarction (RR 0.48) with OPBHC.
- OPBHC had lower risk of incomplete revascularization than off-pump CABG (RR 0.53) but higher than on-pump CABG (RR 1.71).
Conclusions:
- OPBHC is effective for surgical revascularization in high-risk patients.
- OPBHC prevents hemodynamic deterioration and ensures adequate end-organ perfusion.
- OPBHC is a valuable alternative to on-pump and off-pump CABG, especially in patients with recent myocardial infarction or left ventricular dysfunction.
Background:
Operative technique for surgical myocardial revascularization in high-risk patients remains an argument of debate. On-pump coronary artery bypass graft (CABG) with cardioplegic arrest and off-pump CABG have intrinsic limitations. The hybrid approach of on-pump beating-heart CABG (OPBHC) has been proposed over the years with conflicting results. This systematic review and meta-analysis intends to summarize the contemporary literature.
Methods:
A literature search was conducted through major electronic databases. The systematic review provided a total of 279 articles, of those 17 studies were included in the present study.
Results:
Compared with on-pump CABG, OPBHC patients showed a preoperative higher risk profile but had reduced early mortality (risk ratio [RR], 0.59, 95% CI, 0.36-0.97) and reduced postoperative stroke (RR, 0.60, 95% CI, 0.39-0.91). Also, interesting trends towards reduced postoperative intra-aortic balloon pump use (RR, 0.56, 95% CI, 0.31-1.01) and myocardial infarction (RR, 0.48, 95% CI, 0.22-1.07) were observed. Baseline characteristics and postoperative complications were similar between OPBHC and off-pump CABG, but limited data are available. The risk of incomplete revascularization in OPBHC is lower than off-pump CABG (RR, 0.53, 95% CI, 0.33-0.87) but higher than conventional on-pump CABG (RR, 1.71, 95% CI, 1.23-2.39).
Conclusion:
OPBHC is an effective technique to perform surgical revascularization in high-risk patients as preventing haemodynamic deterioration and guaranteeing adequate end-organ perfusion. OPBHC represents an alternative technique to on-pump and off-pump CABG, in those cases in which complications deriving from cardioplegic arrest or manipulation of the heart are more likely. For these reasons, OPBHC might be useful in patients with recent myocardial infarction or with left ventricular dysfunction.
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