Review
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World J Methodol. Mar 26, 2014; 4(1): 6-10
Published online Mar 26, 2014. doi: 10.5662/wjm.v4.i1.6
Off-pump coronary artery bypass grafting: Misperceptions and misconceptions
Shahzad G Raja, Umberto Benedetto
Shahzad G Raja, Umberto Benedetto, Department of Cardiac Surgery, Harefield Hospital, Middlesex UB9 6JH, United Kingdom
Author contributions: Raja SG conceived the study, drafted, edited and revised the manuscript; Benedetto U performed literature search, drafted and helped with revision; all authors read and approved the final manuscript.
Correspondence to: Shahzad G Raja, MRCS, FRCS (C-Th), Department of Cardiac Surgery, Harefield Hospital, Hill End Rd, Harefield, Middlesex UB9 6JH, United Kingdom. drrajashahzad@hotmail.com
Telephone: +44-189-5828550 Fax: +44-189-5828992
Received: December 8, 2013
Revised: February 1, 2014
Accepted: March 13, 2014
Published online: March 26, 2014
Processing time: 107 Days and 16.7 Hours
Abstract

Coronary artery bypass grafting (CABG) continues to be one of the most commonly performed cardiac surgical procedures worldwide. Conventional CABG performed on cardiopulmonary bypass termed on-pump CABG is regarded as the gold standard. However, on-pump CABG results in several physiologic derangements including but not limited to thrombocytopenia, activation of complement factors, immune suppression, and inflammatory responses leading to organ dysfunction. Furthermore, manipulating an atherosclerotic ascending aorta during cannulation and cross-clamping can predispose to embolization and stroke risk. Recognition of these detrimental effects of on-pump CABG resulted in resurgence of off-pump CABG nearly two decades ago. Off-pump CABG since its resurgence has been a subject of intensive scrutiny and speculation. Despite numerous retrospective nonrandomized studies, prospective randomized trials, and meta-analyses validating the safety and efficacy of off-pump CABG, opponents of the technique have persistently demanded abandonment of off-pump CABG. Several misconceptions and misperceptions are used as an excuse for such demands. This review article examines published scientific evidence to evaluate these misperceptions and misconceptions about off-pump CABG.

Keywords: Coronary artery bypass grafting; Cardiopulmonary bypass; Off-pump coronary artery bypass grafting; Surgical myocardial revascularization; Coronary artery surgery

Core tip: There is reluctance to adopt off-pump coronary artery bypass grafting owing to concerns about incomplete revascularization, poor graft patency, and long-term mortality. These concerns are the result of misperceptions and misconceptions rather than reality. This manuscript attempts to tackle these misperceptions and misconceptions.