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J Thorac Cardiovasc Surg 2003;125:779-781
© 2003 The American Association for Thoracic Surgery

Editorials

Off-pump coronary artery bypass surgery: The implications of the evidence

Raimondo Ascione, MD, Gianni D. Angelini, FRCS

From the Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.

Received for publication June 30, 2002. Revisions requested July 1, 2002; revisions received July 30, 2002. Accepted for publication Aug 6, 2002. Address for reprints: Gianni D. Angelini, MD, Professor of Cardiac Surgery, Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom (E-mail: R.Ascione@bristol.ac.uk).

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   Introduction
 


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  		Dr Ascione

 


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  		Dr Angelini

 
Off-pump coronary artery bypass surgery (OPCAB) has experienced a revival since the early 1990s, with the emergence of two schools of thought. The school in favor of OPCAB emphasizes the potential of reducing morbidity while allowing undeveloped countries to access a program of coronary surgery at reduced cost. The other school expresses concern because of the potential for intraoperative myocardial ischemia, suboptimal anastomoses, and a protracted learning curve. Progressively, a variety of innovative techniques and enabling instruments have made OPCAB a standard procedure. Concomitantly, a large number of observational, case-matched, and, not least, prospective randomized studies have been published. In the absence of recognized guidelines, the decision whether to use on-pump or off-pump techniques is often left to individual surgeons. Many are enthusiastically jumping on the OPCAB bandwagon, whereas others are adopting an even more conservative approach. The result is a significant divergence in the treatment of patients, often even within the same unit, the impact of which remains uncertain. There is an urgent need to evaluate the available evidence in a measured and scientific fashion to prevent this gut feeling-based disparity of treatment.


   The evidence
 
The ancient Romans aiming to please the people used to say, "Vox populi, vox dei!" when deciding in the arena whether to put their thumbs up or (mostly) down. In the same way, when auditing the efficacy of a new technique, the surgical scientific community has shown lack of methodology and consistency, in most cases leaving events to sort themselves out. This has been fortunate with the advent in coronary surgery of the left internal thoracic artery graftGo 1 but rather disappointing in other cases, such as . . . [Full Text of this Article]




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