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Off-pump versus on-pump coronary artery bypass grafting 

Off-pump versus on-pump coronary artery bypass grafting
Off-pump versus on-pump coronary artery bypass grafting
Core Concepts in Cardiac Surgery

Michael E. Halkos

, Emmanuel Moss

, and John D. Puskas


Although an abundance of literature comparing on-pump (ONCAB) versus off-pump (OPCAB) coronary artery bypass grafting exists, the optimal surgical strategy remains controversial. While many centers have adopted off-pump techniques, OPCAB surgery remains in the minority of coronary artery bypass grafting procedures performed in the United States. Proponents of ONCAB cite the lack of convincing data in randomized trials demonstrating a benefit for OPCAB, while also citing large observational and registry data that suggest an associated reduction of in-hospital mortality and morbidity with OPCAB. Even more controversial are the reports of graft patency, completeness of revascularization, and the need for repeat revascularization. The advantages and limitations of off-pump surgery, along with its technical considerations, are discussed in detail in this chapter.

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