Off-pump coronary surgery: current justifications

Although the literature has failed to project an overall superiority of off-pump vs. on-pump surgery, nevertheless, small randomized control trials and large meta-analysis studies have concluded that the incidence of a stroke is less than 1 % when anaortic off-pump techniques are advocated in patien...

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Bibliographic Details
Published in:General thoracic and cardiovascular surgery 2014-11, Vol.62 (11), p.660-670
Main Authors: Parissis, Haralabos, Ramesh, B. C., Al-Alao, Bassel
Format: Article
Language:English
Subjects:
Age Factors
Aorta - surgery
Arrests
Atrial Fibrillation - etiology
Calcification
Cardiac arrhythmia
Cardiac Surgery
Cardiology
Cardiopulmonary Bypass - adverse effects
Comorbidity
Coronary Artery Bypass, Off-Pump - adverse effects
Coronary Artery Bypass, Off-Pump - methods
Coronary vessels
Gender
Heart surgery
Hemodynamics
Humans
Ischemia
Medicine
Medicine & Public Health
Observational studies
Patients
Review Article
Risk Factors
Sex Factors
Stroke
Stroke - etiology
Surgeons
Surgical Oncology
Thoracic Surgery
Trends
Veins & arteries
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Summary:Although the literature has failed to project an overall superiority of off-pump vs. on-pump surgery, nevertheless, small randomized control trials and large meta-analysis studies have concluded that the incidence of a stroke is less than 1 % when anaortic off-pump techniques are advocated in patients with diseased ascending aorta. Furthermore, off-pump techniques or their combination with hybrid procedures may lead to a reduction of adverse outcome in the aged high-risk population with concomitant poor left ventricular function and co-morbidities. However, despite this, controversy still exists among the cardiac surgery community in terms of the benefit of this technique and its safety; hence, off-pump is becoming out of fashion. In this review paper, by looking at a “marginal group of patients” (elderly, high risks, atherosclerotic aortas) we attempt to re-establish and justify this technique and re-invent its usage.
ISSN:1863-6705
1863-6713
DOI:10.1007/s11748-014-0470-2