Abstract
Coronary artery bypass grafting (CABG) is well recognized as the standard of care for patients with multi-vessels coronary artery disease. The risk of CABG is reducing due to better cardiopulmonary bypass (CPB), anaesthetic, and operating technique. It is believed that by avoiding CPB, off-pump CABG (OPCAB) may further reduce the risk of CABG and the related cost. However, the controversy for OPCAB remains the conversion risk, graft patency, and completeness of revascularization.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Westaby S, Benetti FJ. Less invasive coronary surgery: consensus from the Oxford Meeting. Ann Thorac Surg. 1996;62:924–31.
Demikhov VP. Experimental transplantation of vital organs. [authorized translation from Russian by Basil Haigh]. New York: Consultant’s Bureau Enterprises; 1962. p. 220–7.
Spencer FC, Galloway AC, Colvin SB. Surgical management of coronary artery disease. Bypass grafting for coronary artery disease. In: Sabiston Jr DC, Spencer FC, editors. Surgery of the chest. 6th ed. Philadelphia: WB Saunders; 1995. p. 1884–5.
Benetti FJ, Naselli G, Wood M, Geffner L. Direct myocardial revascularization without extracorporeal circulation. Experience in 700 patients. Chest. 1991;100:312–6.
Buffolo E, Silva de Andrade JC, Rodrigues Branco JN, et al. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg. 1996;61:63–6.
Kirklin JK, Westaby S, Blackstone EH, Kirklin JW, Chenoweth DE, Pacifico AD. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1983;86:845–57.
Edmunds LH. Inflammatory response to CPB. Ann Thorac Surg. 1998;66:S12–6 [discussion S25–8].
Butler J, Parker D, Pillai R, Westaby S, Shale DJ, Rocker GM. Effect of cardiopulmonar bypass on systemic release of neutrophil elastase and tumor necrosis factor. J Thorac Cardiovasc Surg. 1993;105:25–30.
Ip-Yam PC, Murphy S, Baines M, Fox MA, Desmond MJ, Innes PA. Renal function and proteinuria after CPB: the effects of temperature and mannitol. Anesth Analg. 1994;78:842–7.
Hickey P, Buckley M, Philibin D. Pulsatile and nonpulsatile CPB: review of a counterproductive controversy. Ann Thorac Surg. 1983;36:720–37.
Clark RE, Brillman J, Davies DA, et al. Microemboli during coronary artery bypass grafting: genesis and effect on outcome. J Thorac Cardiovasc Surg. 1995;109:249–57.
Møller CH, Penninga L, Wetterslev J, Steinbrüchel DA, Gluud C. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. Cochrane Database Syst Rev. 2012;3:CD007224.
Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et al. Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year. N Engl J Med. 2013;368(13):1179–88.
Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S, et al. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med. 2004;350(1):21–8.
Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet. 2002;359:1194–9.
Angelini GD, Culliford L, Smith DK, Hamilton MC, Murphy GJ, Ascione R, et al. Effects of on- and off-pump coronary artery surgery on graft patency, survival, and health-related quality of life: long-term follow-up of 2 randomized controlled trials. J Thorac Cardiovasc Surg. 2009;137(2):295–303.e5.
Hueb W, Lopes NH, Pereira AC, Hueb AC, Soares PR, Favarato D, et al. Five-year follow-up of a randomized comparison between off-pump and on-pump stable multivessel coronary artery bypass grafting. The MASS III Trial. Circulation. 2010;122(11 Suppl):S48–52.
Ascione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD. On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg. 1999;68:493–8.
Wijeysundera DN, Beattie WS, Djaiani G, Rao V, Borger MA, Karkouti K, et al. Off-pump coronary artery surgery for reducing mortality and morbidity: meta-analysis of randomized and observational studies. J Am Coll Cardiol. 2005;46(5):872–82.
Kuss O, von Salviati B, Börgermann J. Off-pump versus onpump coronary artery bypass grafting: a systematic review and meta-analysis of propensity score analyses. J Thorac Cardiovasc Surg. 2010;140(4):829–35, 835.e1–13.
Hernandez F, Brown JR, Likosky DS, Clough RA, Hess AL, Roth RM, et al. Neurocognitive outcomes of off-pump versus on-pump coronary artery bypass: a prospective randomized controlled trial. Ann Thorac Surg. 2007;84(6):1897–903.
Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ, et al. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125(4):797–808.
Lund O, Christensen J, Holme S, Fruergaard K, Olesen A, Kassis E, et al. On-pump versus off-pump coronary artery bypass: independent risk factors and off-pump graft patency. Eur J Cardiothorac Surg. 2001;20(5):901–7.
Al-Ruzzeh S, Nakamura K, Athanasiou T, Modine T, George S, Yacoub M, et al. Does off-pump coronary artery bypass (OPCAB) surgery improve the outcome in high-risk patients?: comparative study of 1398 high-risk patients. Eur J Cardiothorac Surg. 2003;23(1):50–5.
Puskas JD, Thourani VH, Kilgo P, Cooper W, Vassiliades T, Vega JD, Morris C, Chen E, Schmotzer BJ, Guyton RA, Lattouf OM. Off-pump coronary artery bypass disproportionately benefits high-risk patients. Ann Thorac Surg. 2009;88(1552–6259 (Electronic), 4):1142–7.
Bakaeen FG, Shroyer AL, Gammie JS, Sabik JF, Cornwell LD, Coselli JS, et al. Trends in use of off-pump coronary artery bypass grafting: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg. 2014. pii: S0022-5223(14)00023-3.
The Society for Cardiothoracic Surgery in Great Britain & Ireland. Sixth National adult cardiac surgical database report 2008. http://www.scts.org/_userfiles/resources/SixthNACSDreport2008withcovers.pdf.
Vettath M, Ismail E, Kannan A. Re-engineering in OPCAB—a Vettath’s perspective. World J Cardiovasc Dis. 2013;3:33–44.
Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med. 2012;366:1489–97.
Sepic J, Wee JO, Soltesz EG, Hsin MK, Cohn LH, Laurence RG, et al. Cardiac positioning using an apical suction device maintains beating heart hemodynamics. Heart Surg Forum. 2002;5:279–84.
Mishra M, Malhotra R, Mishra A, Meharwal ZS, Trehan N. Hemodynamic changes during displacement of the beating heart using epicardial stabilization for off-pump coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2002;16:685–90.
Couture P, Denault A, Limoges P, Sheridan P, Babin D, Cartier R. Mechanisms of hemodynamic changes during off-pump coronary artery bypass surgery. Can J Anaesth. 2002;49:835–49.
Gandra SM, Rivetti LA. Experimental evidence of regional myocardial ischemia during beating heart coronary bypass: prevention with temporary intraluminal shunts. Heart Surg Forum. 2002;6:10–8.
Gründeman PF, Borst C, van Herwaarden JA, Verlaan CW, Jansen EW. Vertical displacement of the beating heart by the octopus tissue stabilizer: influence on coronary flow. Ann Thorac Surg. 1998;65:1348–52.
Izutani H, Gill IS. Acute graft failure caused by an intracoronary shunt in minimally invasive direct coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125:723–4.
Shanewise J, Ramsay J. Off-pump coronary surgery: how do the anesthetic considerations differ? Anesthesiol Clin North Am. 2003;21:613–23.
Shanewise JS, Zaffer R, Martin RP. Intraoperative echocardiography and minimally invasive cardiac surgery. Echocardiography. 2002;19:579–82.
Gayes JM, Emery RW, Nissen MD. Anesthetic considerations for patients undergoing minimally invasive coronary artery bypass surgery: mini-sternotomy and mini-thoracotomy approaches. J Cardiothorac Vasc Anesth. 1996;10(4):531–5.
Nierich AP, Diephuis J, Jansen EW, van Dijk D, Lahpor JR, Borst C, et al. Embracing the heart: perioperative management of patients undergoing off-pump coronary artery bypass grafting using the octopus tissue stabilizer. J Cardiothorac Vasc Anesth. 1999;13(2):123–9.
Guyton RA, Thourani VH, Puskas JD, Shanewise JS, Steele MA, Palmer-Steele CL, et al. Perfusion-assisted direct coronary artery bypass: selective graft perfusion in off pump cases. Ann Thorac Surg. 2000;69:171.
Edgerton JR, Dewey TM, Magee MJ, Herbert MA, Prince SL, Jones KK, et al. Conversion in off pump coronary artery bypass grafting: an analysis of predictors and outcomes. Ann Thorac Surg. 2003;76:1138.
Mujanovic E, Kabil E, Hadziselimovic M, Softic M, Azabagic A, Bergsland J. Conversions in off pump coronary surgery. Heart Surg Forum. 2003;6:135.
Shroyer AL, Grover FL, Hattler B, Collins JF, McDonald GO, Kozora E, et al. Veterans Affairs Randomized On/Off Bypass (ROOBY) Study Group. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med. 2009;361(19):1827–37.
Gao C, Liu Z, Li B, Xiao C, Wu Y, Wang G, et al. Comparison of graft patency for off-pump and conventional coronary arterial bypass grafting using 64-slice multidetector spiral computed tomography angiography. Interact Cardiovasc Thorac Surg. 2009;8(3):325–9.
Houlind K, Kjeldsen BJ, Madsen SN, Rasmussen BS, Holme SJ, Nielsen PH, et al. On-pump versus off-pump coronary artery bypass surgery in elderly patients: results from the Danish on-pump versus off-pump randomization study. Circulation. 2012;125(20):2431–9.
Uva MS, Matias F, Cavaco S, Magalhães MP. Rationale, design and methodology for a Prospective Randomized Study of graft patency in Off-pump and On-pump MultI-vessel coronary artery bypasS Surgery (PROMISS) using multidetector computed tomography. Trials. 2008;9:44.
Puskas JD, Williams WH, Mahoney EM, Puskas JD, Williams WH, Mahoney EM, Huber PR, Block PC, Duke PG, et al. Off-pump vs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial. JAMA. 2004;291(15):1841–9.
Takagi H, Matsui M, Umemoto T. Lower graft patency after off-pump than on-pump coronary artery bypass grafting: an updated meta-analysis of randomized trials. J Thorac Cardiovasc Surg. 2010;140(3):e45–7.
Uva MS, Cavaco S, Oliveira AG, Matias F, Silva C, Mesquita A, et al. Early graft patency after off-pump and onpump coronary bypass surgery: a prospective randomized study. Eur Heart J. 2010;31(20):2492–9.
Magee MJ, Alexander JH, Hafley G, Ferguson Jr TB, Gibson CM, Harrington RA, et al. Coronary artery bypass graft failure after on-pump and off-pump coronary artery bypass: findings from PREVENT IV. Ann Thorac Surg. 2008;85(2):494–9.
Kinoshita T, Asai T, Suzuki T. Preoperative SYNTAX score and graft patency after off-pump coronary bypass surgery. Eur J Cardiothorac Surg. 2013;44(1):e25–31.
Lamy A, Tong W, Devereaux PJ, Gao P, Gafni A, Singh K, et al. The cost implications of off-pump versus on-pump coronary artery bypass graft surgery at one year. Ann Thorac Surg. 2014;98(5):1620–5.
Lemma M, Atanasiou T, Contino M. Minimally invasive cardiac surgery-coronary artery bypass graft. Multimed Man Cardiothorac Surg. 2013;2013:mmt007.
Lapierre H, Chan V, Sohmer B, Mesana TG, Ruel M. Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study. Eur J Cardiothorac Surg. 2011;40:804–10.
Ruel M, Shariff MA, Lapierre H, Goyal N, Dennie C, Sadel SM, et al. Results of the minimally invasive coronary artery bypass grafting angiographic patency study. J Thorac Cardiovasc Surg. 2014;147(1):203–8.
Harskamp RE, Bagai A, Halkos ME, Rao SV, Bachinsky WB, Patel MR, et al. Clinical outcomes after hybrid coronary revascularization versus coronary artery bypass surgery: a meta-analysis of 1190 patients. Am Heart J. 2014;167:585–92.
Gerli C, Mantovani L, Franco A, De Luca M, Bergonzi PC, Boroli F, et al. Redo coronary artery bypass grafting on the beating heart and transfusion needs. Minerva Anestesiol. 2006;72:985–93.
Kara I, Cakalagaoglu C, Ay Y, Al Salehi S, Yanartas M, Anasiz H, et al. Reoperative coronary artery bypass surgery: the role of on-pump and off-pump techniques on factors affecting hospital mortality and morbidity. Ann Thorac Cardiovasc Surg. 2013;19(6):435–40. Epub 2013 Feb 15.
Dohi M, Miyata H, Doi K, Okawa K, Motomura N, Takamoto S, Yaku H, Japan Cardiovascular Surgery Database. The off-pump technique in redo coronary artery bypass grafting reduces mortality and major morbidities: propensity score analysis of data from the Japan Cardiovascular Surgery Database. Eur J Cardiothorac Surg. 2015;47(2):299–308.
Mishra YK, Collison SP, Malhotra R, Kohli V, Mehta Y, Trehan N. Ten-year experience with single-vessel and multivessel reoperative off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2008;135(3):527–32.
Sepehripour AH, Suliman A, Stavridis G, Athanasiou T. Is the evidence from first time off-pump coronary artery bypass graft surgery transferable to re-operative off-pump surgery? Expert Rev Cardiovasc Ther. 2014;12(11):1327–35.
Sepehripour AH, Harling L, Ashrafian H, Casula R, Athanasiou T. Does off-pump coronary revascularization confer superior organ protection in re-operative coronary artery surgery? A meta-analysis of observational studies. J Cardiothorac Surg. 2014;9:115. doi:10.1186/1749-8090-9-115. Review.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Kwok, M.W.T., Lau, R.W.H., Wong, R.H.L., Underwood, M.J. (2016). Coronary Artery Bypass Surgery: On-pump and Off-pump Techniques. In: Ţintoiu, I., Underwood, M., Cook, S., Kitabata, H., Abbas, A. (eds) Coronary Graft Failure. Springer, Cham. https://doi.org/10.1007/978-3-319-26515-5_2
Download citation
DOI: https://doi.org/10.1007/978-3-319-26515-5_2
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-26513-1
Online ISBN: 978-3-319-26515-5
eBook Packages: MedicineMedicine (R0)