Off pump vs on pump CABG
On pump CABG is the conventional method in which heart is arrested using potassium rich cardioplegia solution and the heart lung machine takes over the circulatory and gas exchange functions of the body. In off pump CABG, heart is fixed using suction devices and it continues to beat while bypass grafting is done. But the procedure is technically more demanding for surgical skill and potential risk of incomplete revascularization may occur. The theoretical advantages of off pump CABG are the reduction of systemic inflammatory state related to cardiopulmonary bypass, microemboli, increased permeability of blood brain barrier and aortic manipulation during cross clamping and cannulation. In spite of these theoretical advantages, one study showed that number of off pump CABG in United States declined from a peak level of 23% 2002 to 17% in 2012 . According to that report, a minority of surgeons and centres do perform off pump CABG in most of their patients. In a comment to this report another author commented that off pump CABG requires careful patient selection and special expertise to achieve the potential benefits .
Bakaeen FG et al. Trends in use of off-pump coronary artery bypass grafting: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg. 2014;148:856-863.
Chen X. The benefits of off-pump coronary artery bypass grafting require careful patient selection and special expertise. J Thorac Cardiovasc Surg. 2015 Sep;150(3):735-6.