offpump

Off-pump coronary artery bypass grafting (OPCAB), commonly called offpump, is a surgical approach to revascularize the heart without using the cardiopulmonary bypass machine. The heart continues to beat during the procedure, and surgeons stabilize only the area being grafted while global circulation remains supported by the patient’s native physiology.

During OPCAB, specialized stabilizers and repositionable devices minimize movement at the target coronary site. Conduits, such as the left internal thoracic artery, saphenous vein, or radial artery, are anastomosed to diseased arteries. Some techniques avoid touching the ascending aorta (anaortic OPCAB) to reduce embolic stroke risk.

History and adoption: OPCAB emerged in the 1990s as an alternative to conventional on-pump CABG. Adoption varies by center and surgeon experience, as the technique is technically demanding and has a learning curve. Potential advantages include a reduced systemic inflammatory response, less blood transfusion, and shorter ventilation; potential drawbacks include longer operative times and concerns about incomplete revascularization or graft patency in some cases.

Outcomes and evidence: Randomized trials and meta-analyses have produced mixed results. Some studies show no difference in mortality or major cardiac events compared with on-pump CABG, with possible reductions in certain complications. Others report higher rates of incomplete revascularization or lower graft patency in some settings, particularly early in the learning curve. Overall, results appear to depend on patient selection and surgeon experience, with contemporary practice often using OPCAB selectively or in anaortic strategies.