Commentary: Off-pump surgery —Choice, not religion

For more than 2  decades, we have examined the value of off-pump coronary artery bypass grafting surgery. It has been the subject of single-institution and single-surgeon reports, randomized trials, and observational studies that have used a myriad of statistical adjustment strategies in attempts to allow comparis ons with a variety of on-pump strategies. The most common question addressed has been “Should off-pump surgery be the standard strategy used by most surgeons for most patients undergoing coronary artery bypass grafting surgery?” As their stories have unfolded, the largest studies involving heter ogeneous groups of surgeons and patients have shown that off-pump surgery appears to achieve slight decreases in perioperative morbidity, most consistently the rates of blood transfusion, stroke, and renal complications (as in the study Rufa and colleagues1), but at the price of a decrease in the ra te of complex arterial grafting (itself a strategy with incomplete acceptance), a decrease in complete revascularization, and, at least in some studies, a slight decrease in long-term graft patency rate and patient survival.
Source: The Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Commentary Source Type: research