Off pump coronary artery bypass

Abstract

Off pump coronary artery bypass (OPCAB) is a technique of surgical coronary artery revascularization that is accomplished without the use of cardiopulmonary bypass. The off pump technique is theoretically advantageous in that it avoids the cardiopulmonary bypass machine (often referred to as the “pump”), cardioplegia, and full aortic cross clamping. Large-scale studies have not shown a significant difference in mid-term OPCAB outcomes compared to on pump coronary artery bypass, but further large and long-term randomized controlled trials are needed to determine the best surgical technique. Despite ongoing study, OPCAB is being used for selective indications and in centers with high surgical experience. In this chapter, we discuss historical perspectives of OPCAB, a comparison between on pump and off pump coronary artery bypass, and the surgical and anesthetic considerations of OPCAB. We conclude with a discussion of the potential complexities associated with the OPCAB technique.