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(Circulation. 2008;117:2181-2183.)
© 2008 American Heart Association, Inc.

Editorial

Can the Off-Pump Coronary Artery Bypass Debate Shed Light on Postoperative Right Heart Dysfunction?

Michael J. Davidson, MD

From the Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Michael J. Davidson, MD, Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA 02115. E-mail mdavidson@partners.org

Key Words: Editorials • cardioplegia • cardiopulmonary bypass • coronary disease • imaging • surgery

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

The debate over the relative merits of off-pump coronary artery bypass grafting (OPCAB) and conventional on-pump coronary artery bypass grafting (CABG) continues unabated and remains an area of great controversy. Given the known effects of cardiopulmonary bypass (CPB) on the inflammatory and coagulation cascades, as well as a suggestion of adverse neurological sequelae, there has been a logical argument to perform surgical revascularizations without its use. Proponents of OPCAB have cited advantages in terms of neurological outcomes, renal function, blood use, cost, length of stay, arrhythmias, infections, and ventricular function.^1–3 Critics assert that OPCAB is more technically demanding than conventional CABG, and, moreover, that consistent data showing sustained benefits have been lacking and that some existing data suggest inferior revascularization.^4,5 At present, analyses of randomized controlled trials have generally shown that OPCAB results in outcomes equivalent to those of conventional CABG in terms of mortality, long-term neurological function, and revascularization while reducing rates of blood use, renal impairment, and cost.^3,6–8 Given the steep learning curve of OPCAB and lack of clear long-term cardiovascular or neurological benefit, however, many surgeons have reverted to or continued to favor conventional CABG as their strategy of choice. One criticism leveled at OPCAB is that the results reported usually come from surgeons and centers that are exceptionally experienced in the technique. Given the significantly higher technical demands of OPCAB, results equivalent to conventional CABG may not be applicable to most practicing surgeons. The implication, though unproven, is that the average cardiac surgeon might experience worse . . . [Full Text of this Article]

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