Off pump coronary artery bypass graft

  • H J Moutlana University of the Witwatersrand

Abstract

Coronary artery bypass graft (CABG) using a graft anastomosed between the aorta and the coronary artery distal to the lesion is the first broadly accepted surgery for coronary artery disease (CAD). The procedure was initially performed off-pump, because cardiopulmonary bypass (CPB) was not available.1 Off-pump coronary artery bypass (OPCAB) surgery was first performed and reported in the 1960s.2-4 Most surgeons started preferring to do CABG using CPB after the development of CPB and cardioplegia.5 The use of OPCAB technique continued despite the controversy surrounding the long-term graft patency rates, which have been shown to be better following on-pump CABG.1,2,6 The performance of CABG using the off-pump technique regained momentum in the 1980s, and it was mostly favoured in centres with resource limitations.4,5 OPCAB provides the potential benefits associated with the avoidance of CPB, which includes reduction of systemic inflammatory response, coagulopathy4,5,7,8 renal dysfunction and cerebral impairment.2,5,7 The refinement of surgical techniques as well as the creation of better cardiac stabilising retractors has made OPCAB an established procedure,5 which has shown to produce favourable outcomes, especially in high risk patients.2,4,7

Author Biography

H J Moutlana, University of the Witwatersrand
Department of Anaesthesia Chris Hani Baragwanath Academic Hospital University of the Witwatersrand
Published
2018-05-28
Section
FCA Refresher Course