Off-Pump Versus On-Pump Coronary Bypass Surgery
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To the Editor:
A careful, randomized study of coronary artery bypass surgery (CABG) concluded that, “in selected patients, off-pump CABG [OFFCABG] is safe and yields short-term cardiac outcomes comparable to that of on-pump CABG [ONCABG].”1 Despite this positive interpretation, OFFCABG had no benefit in these highly selected patients in the ways in which it was most expected: intensive care unit stay, stroke, atrial fibrillation, quality of life, and hospital cost.
The authors attribute lower creatine kinase muscle-brain isoenzyme release in OFFCABG patients to less ischemia from individual coronary artery clamping, compared with the global ischemia often used during ONCABG. Actually, local vessel clamping is also appropriate (and is even more convenient) during ONCABG.2 Alternatively, ONCABG can be done with brief periods of intermittent global ischemia,3 thus gaining the benefits of ischemic preconditioning.
It is also disappointing that the patients and their …