Off-Pump Coronary Artery Bypass Grafting

Abstract

Coronary artery bypass grafting (CABG) is the standard of care for revascularization of left main and three-vessel coronary artery disease. Conventional CABG utilizing cardiopulmonary bypass (CPB) often termed on-pump CABG is regarded as the gold standard. However, the morbidity and mortality associated with conventional CABG is attributed to invasiveness of CPB and 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 CABG nearly two decades ago. Theoretically off-pump CABG, by avoiding CPB, may improve outcomes by reducing organ dysfunction. Several high-quality clinical trials have been conducted since off-pump CABG became popular in the 1990s and have failed to prove outright superiority of off-pump CABG over on-pump CABG with respect to key outcomes. At the same time concerns regarding completeness of revascularization, graft patency and long-term survival have prevented the universal adoption of off-pump CABG. This chapter provides an overview of the evolution, technique, and outcomes of off-pump CABG as well as concerns and controversies associated with it.