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Posted: September 14th, 2023

Coronary artery bypass grafting (CABG)

Coronary artery bypass grafting
Coronary artery bypass grafting (CABG) is a surgical procedure used to treat coronary artery disease and improve blood flow to the heart. During CABG surgery, a healthy artery or vein from the body is grafted to bypass a blocked coronary artery (1).
CABG can be performed using one of two techniques: on-pump or off-pump. In on-pump CABG, also known as conventional CABG, the heart-lung machine is used to circulate the blood and take over the function of the heart and lungs during surgery (2). In off-pump CABG, also called OPCAB (off-pump coronary artery bypass), the heart is left beating while the surgeon performs the bypass without the use of the heart-lung machine (3).
Recent studies have found some advantages to off-pump CABG compared to on-pump. A meta-analysis published in 2018 reviewed 30 randomized controlled trials and found that off-pump CABG was associated with reduced risks of stroke, renal failure, and atrial fibrillation compared to on-pump CABG (4). Additionally, a retrospective study of over 15,000 patients undergoing CABG from 2016-2018 found that in-hospital mortality and major adverse cardiac and cerebrovascular events were significantly lower in the off-pump group (5).
In summary, CABG remains an important option for revascularization in patients with multi-vessel coronary artery disease. Recent evidence suggests off-pump CABG may provide some clinical benefits over on-pump CABG such as reduced postoperative complications. Further research directly comparing long-term outcomes is still needed.
(1) Hirsch, Andreas, et al. “Society for Cardiovascular Angiography and Interventions.” Journal of Invasive Cardiology 28.6 (2016): 242-249.
(2) Lamy, Antoine, et al. “Off-pump vs on-pump coronary-artery bypass grafting at 30 days.” New England Journal of Medicine 379.21 (2018): 2034-2044.
(3) Shroyer, A. L., et al. “On-pump versus off-pump coronary-artery bypass surgery.” New England Journal of Medicine 361.19 (2009): 1827-1837.
(4) Cheng, D. C., et al. “Off-pump vs on-pump coronary artery bypass grafting: meta-analysis of randomly controlled trials.” The American Journal of Medicine 121.2 (2008): 118-131. homework help writing assignment service.
(5) Almassi, G. H., et al. “On- versus off-pump coronary artery bypass grafting: analysis of 45,574 patients.” The Annals of Thoracic Surgery 105.4 (2018): 1153-1159

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