Harold L Lazar1. 1. Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Abstract
PURPOSE OF REVIEW: This review will examine the current role of off-pump coronary artery bypass (OPCAB) surgery compared with on-pump coronary artery bypass (ONCAB) surgery for the revascularization of ischemic myocardium. RECENT FINDINGS: Recent studies have confirmed earlier findings that OPCAB is associated with less grafts per patient and less complete revascularization, and increased incidence of recurrent angina and need for repeat revascularization procedures, and more frequent rehospitalization for cardiac-related issues. OPCAB does not prevent postoperative renal dysfunction and is associated with worse long-term outcomes. Hospital costs are not reduced and are increased in those OPCAB patients who require intraoperative conversion to ONCAB procedures; however, when multiple arterial grafts are used and a complete revascularization is performed, OPCAB outcomes are equivalent to those of ONCAB procedures. SUMMARY: OPCAB should only be performed by surgeons experienced in this technique in patients in whom a complete revascularization can be achieved; preferably with multiple arterial grafts.
PURPOSE OF REVIEW: This review will examine the current role of off-pump coronary artery bypass (OPCAB) surgery compared with on-pump coronary artery bypass (ONCAB) surgery for the revascularization of ischemic myocardium. RECENT FINDINGS: Recent studies have confirmed earlier findings that OPCAB is associated with less grafts per patient and less complete revascularization, and increased incidence of recurrent angina and need for repeat revascularization procedures, and more frequent rehospitalization for cardiac-related issues. OPCAB does not prevent postoperative renal dysfunction and is associated with worse long-term outcomes. Hospital costs are not reduced and are increased in those OPCAB patients who require intraoperative conversion to ONCAB procedures; however, when multiple arterial grafts are used and a complete revascularization is performed, OPCAB outcomes are equivalent to those of ONCAB procedures. SUMMARY: OPCAB should only be performed by surgeons experienced in this technique in patients in whom a complete revascularization can be achieved; preferably with multiple arterial grafts.
Authors: Mariusz Kowalewski; Marek Jasiński; Jakub Staromłyński; Marian Zembala; Kazimierz Widenka; Mirosław Brykczyński; Jacek Skiba; Michał Zembala; Krzysztof Bartuś; Tomasz Hirnle; Inga Dziembowska; Piotr Knapik; Zdzisław Tobota; Bohdan Maruszewski; Piotr Suwalski Journal: PLoS One Date: 2020-04-22 Impact factor: 3.240