Off-Pump Coronary Bypass Surgery

Coronary artery bypass grafting (CABG) is one of the most frequently performed operations worldwide. Its application is expected to increase, particularly in the developing world, where the incidence of coronary heart disease continues to rise.1 Any improvement in the safety and efficacy of the procedure or any means to increase the rate of its application, however small, would have a major impact in absolute terms. One potential method for achieving some of these objectives is off-pump coronary artery bypass grafting (OPCAB), which appears to be gaining in popularity. Although this method is intellectually appealing, with many theoretical and practical advantages, there are still major concerns2,3 because the technique could have significant complications in both the short and the long term. These issues need to be addressed if the technique is to establish its identity and role in the treatment of coronary artery disease. In the last few years, there has been a rapid accumulation of knowledge relating to some, but not all, of these issues. This knowledge comes from observational reports, case-matched studies, and importantly, from prospective, randomized trials. In this regard, the report by van Dijk and colleagues4 in this issue of Circulation is a welcome addition to the literature. In the present editorial, a systematic analysis of the available evidence on OPCAB-related issues is made.See p 1761 To date, OPCAB has been used largely in selected patients, with the reported use of the procedure varying widely in different centers (between 0% and >90% of all patients undergoing coronary bypass grafting).5–9 The application of the technique has tended to increase dramatically since the introduction of devices for stabilizing the heart, such as the Octopus, which is used by many centers and was used in the trial by van Dijk et al.4 Initially, the …