On-Pump and Off-Pump Coronary Bypass Surgery

Coronary bypass surgery performed without the use of cardiopulmonary bypass (off-pump surgery) has been used sporadically since the beginning of the bypass surgery era in 1967, but the use of this strategy increased dramatically during the 1990s. The major reason for the increased use of off-pump surgery was the hope that this strategy would decrease perioperative morbidity and possibly mortality by eliminating cardiopulmonary bypass (on-pump surgery). The fear concerning off-pump surgery has been that the difficulty of operating with the heart beating would lead to less complete and less effective revascularization at the time of surgery and worse long-term outcomes.Article p 1145 Whether these hopes and fears are real has been examined by myriad studies that have compared the outcomes for patients undergoing off-pump and on-pump surgery. Randomized trials usually have shown only small differences in perioperative outcomes, usually slightly in favor of off-pump surgery, but have included mostly low-risk patients. Observational trials often have shown bigger differences in short-term complications, usually in favor of off-pump surgery, but analyses of these trials are complicated by patient selection. Follow-up studies, both randomized and observational, have sometimes noted inferior long-term outcomes after off-pump surgery compared with on-pump …