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(Circulation. 2004;109:1206-1211.)
© 2004 American Heart Association, Inc.

Clinician Update

Off-Pump Coronary Artery Bypass Surgery

Fundamentals for the Clinical Cardiologist

Subodh Verma, MD, PhD; Paul W.M. Fedak, MD; Richard D. Weisel, MD; Paul E. Szmitko, BSc; Mitesh V. Badiwala, BSc; Daniel Bonneau, MD; David Latter, MD; Lee Errett, MD; Yves LeClerc, MD

From the Division of Cardiac Surgery, Toronto General Hospital (S.V., P.W.M.F., R.D.W., P.E.S., M.V.B.), and the Division of Cardiac Surgery, St Michael’s Hospital (D.B., D.L., L.E., Y.L.), Toronto, Ontario, Canada.

Correspondence to Subodh Verma, MSc, MD, PhD, Division of Cardiac Surgery, Toronto General Hospital, 200 Elizabeth St, 14 EN-215, Toronto, Ontario, Canada M5G 2C4. E-mail subodh.verma@sympatico.ca

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Case Report: Mrs. G is a 65-year-old retired banker who has had Canadian Cardiovascular Society class III angina for the past 2 months and symptomatic intermittent claudication for the past year. Her past medical history is unremarkable except for the presence of multiple vascular risk factors (smoking, hypertension, dyslipidemia, and diabetes). Coronary angiography revealed triple vessel disease involving the left anterior descending, second obtuse marginal, and right coronary arteries, as well as the akinetic anterior and inferior walls, with an estimated ejection fraction of 30%. Carotid duplex revealed 40% stenosis of the right internal carotid artery and 60% stenosis of the left internal carotid artery. A chest x-ray showed a possible calcified ascending aorta. The patient was referred for consideration of coronary artery bypass graft (CABG) surgery. Is Mrs. G a candidate for off-pump CABG? What are the indications, precautions, and considerations that facilitate decision-making about off-pump CABG surgery?

Conventional CABG surgery uses cardiopulmonary bypass (CPB) to allow cardiac surgeons to operate on a motionless heart that has been arrested by means of cardioplegia. CABG with CPB (on-pump CABG) quickly became the gold standard surgical procedure for myocardial revascularization, as it allowed surgeons to bypass multiple coronary arteries with greater control and precision. However, recently there has been increasing interest in the development and use of technologies that allow surgeons to perform CABG surgery without CPB (known as off-pump CABG or OPCAB).

	Rationale for the Development of OPCAB Surgery

 
CPB is not a benign intervention. It is associated with a number of adverse consequences that are primarily . . . [Full Text of this Article]

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