During off-pump coronary artery bypass graft surgery, the heart is
still beating while the graft attachments are made to bypass a blockage.
While performing on-pump CABG surgery, the heart is stopped and a
heart-lung machine takes over the work for the heart and lungs. This
method has been an effective, safe and time-proven technique and is
considered the gold standard with which all other surgical
revascularization methods have been compared. However, performing
coronary revascularization this way can result in myocardial ischemic
injury, neurocognitive deficits, and strokes and activate inflammatory
pathways that contribute to pulmonary, renal and hematologic
In order to accurately compare the advantages and disadvantages of
OPCAB and to determine what, if any, role it should have in the practice
of surgical coronary artery revascularization, Lazar examined clinical
data from numerous studies worldwide and found the OPCAB technique had
failed to show any significant improvement in short-term morbidity or
According to Lazar a major impetus for performing OPCAB was to avoid
the possible detrimental effects of cardiopulmonary bypass, which
include activation of inflammatory pathways, changes in neurological and
cognitive function and alterations in quality of life. "However,
patients undergoing OPCAB have not shown any benefits in these areas,"
said Lazar, a professor of surgery at Boston University School Medicine.
"Even in those studies in which OPCAB has resulted in a small
improvement in early postoperative outcomes, these improvements are no
longer apparent on long-term follow-up," he added.
In fact, several studies suggest that long-term survival may be
significantly reduced in OPCAB patients compared with patients in whom
on-pump techniques were used. Lazar explains that this may be
attributable to the significant increase in incomplete revascularization
seen in OPCAB patients and may be responsible for the increase in
recurrent angina and need for revascularization procedures seen in OPCAB
"Unless individual surgeons can demonstrate that they can achieve
short- and long-term outcomes with OPCABG that are comparable to on-pump
CABG results, they should abandon this technique," said Lazar.
Source: Boston Medical Center via EurekAlert!