Off pump vs on pump CABG

Off pump CABG vs on pump CABG

On pump CABG is the conventional method in which heart is arrested using potassium rich cardioplegia solution and the heart lung machine takes over the circulatory and gas exchange functions of the body. In off pump CABG (also called OPCAB – Off-pump Coronary Artery Bypass), heart is fixed using suction devices and it continues to beat while bypass grafting is done. But the procedure is technically more demanding for surgical skill and potential risk of incomplete revascularization may occur.

The theoretical advantages of off pump CABG are the reduction of systemic inflammatory state related to cardiopulmonary bypass, microemboli, increased permeability of blood brain barrier and aortic manipulation during cross clamping and cannulation. In spite of these theoretical advantages, one study showed that number of off pump CABG in United States declined from a peak level of 23% in 2002 to 17% in 2012 [1]. According to that report, a minority of surgeons and centres do perform OPCAB in most of their patients. In a comment to this report another author commented that off pump CABG requires careful patient selection and special expertise to achieve the potential benefits [2].

A review of the then status of OPCAB was reported from Japan in 2020 [3]. At that time 65% of CABG procedures in Japan was performed using OPCAB. After a literature review the authors mentioned that many randomized controlled trials indicated that the acute phase and long term mortality rates were comparable between OPCAB and on pump CABG or that OPCAB was inferior to on pump CABG. In contrast, many observational studies had shown that OPCAB was superior to on pump CABG.

The authors concluded that CABG is a delicate procedure and outcomes vary in accordance with patient’s condition as well as the level of expertise of the associated institution and surgeon. They hoped that in future reports will emerge with excellent results including long-term results from Japanese institutions experienced in performing OPCAB.

References

  1. Bakaeen FG 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;148:856-863.

  2. Chen X. The benefits of off-pump coronary artery bypass grafting require careful patient selection and special expertise. J Thorac Cardiovasc Surg. 2015 Sep;150(3):735-6.

  3. Kuwahara G, Tashiro T. Current Status of Off-Pump Coronary Artery Bypass. Ann Thorac Cardiovasc Surg. 2020 Jun 20;26(3):125-132. doi: 10.5761/atcs.ra.18-00286. Epub 2020 May 29. PMID: 32475890; PMCID: PMC7303318.

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