Current results of off-pump coronary artery bypass surgery.

Whether to use or not use cardiopulmonary bypass-cardioplegic arrest to perform coronary artery bypass surgery is the main controversy presently facing our surgical specialty. The reported clinical outcomes are mainly retrospective and highly debatable for conclusiveness regarding the benefits of off-pump surgery. As more centers and larger patient cohorts are analyzed and reported, particularly over the last 2 years, off-pump surgery appears to provide significantly improved outcomes with decreased bleeding and transfusion requirements, less myocardial enzyme release, less ventilatory time, and decreased hospital stay and costs. Reported off-pump benefits for the major outcomes of operative mortality and stroke are encouraging, but less conclusive. From experienced centers, early off-pump angiographic graft patency has been comparable to previously published conventional results. High-risk, elderly patients may benefit the greatest from off-pump surgery. Although in relative technical infancy, off-pump coronary artery bypass grafting has demonstrated enough benefit outcomes that it is no longer an experimental procedure, but a valid surgical revascularization method requiring further investigation and continued usage. Copyright 2003 Elsevier Inc. All rights reserved.