The Evolution of CABG

Conventional coronary artery bypass grafting (CABG) utilizing cardiopulmonary bypass (CPB) and cardioplegic arrest has for many years represented the gold standard in coronary revascularization; however, this situation is now being challenged.

Patients referred for CABG are older, have a higher incidence of co-morbid illnesses, greater severity of coronary artery disease, worse ventricular function, and more frequently require urgent or emergency procedures than compared with 10–20 years ago. Conventional CABG utilizing CPB in these high-risk groups is associated with high complication rates, substantially increased mortality and significantly increased costs.

Advantages of Off-Pump CABG (OPCAB)

Coronary artery bypass grafts performed on the beating heart, without the use of CPB (off-pump or OPCAB) can achieve equivalent multi-vessel revascularization compared to conventional on-pump surgery.

Significant savings compared to conventional on-pump surgery

Particularly effective in high-risk patient groups

The Future of CABG

Despite the apparent benefits, debate continues as to the merits of off-pump surgery. Evidence obtained from randomized controlled trials, case-matched reports and observational studies suggests that OPCAB may replace conventional on-pump as the gold standard for CABG over the next decade.

The reduced morbidity and peri-operative costs, in turn, increase the quantity and quality of care that can be delivered by healthcare systems, making it an increasingly preferred option for appropriate candidates.