Outcomes of off-pump coronary artery bypass grafting in high risk patients

Previous reports have demonstrated that advanced age, chronic lung disease, diabetes, renal dysfunction, atheromatous aorta and severe left ventricular dysfunction are important independent predictors of operative mortality and morbidity after coronary artery bypass grafting (CABG). In addition, cardiopulmonary bypass (CPB) is associated with diffuse systemic inflammatory responses during and after cardiac surgery and may contribute to the morbidity associated with CABG. Off-pump coronary artery bypass (OPCAB) grafting has emerged as an alternative technique allowing coronary revascularization without the risk associated with CPB. The debate on whether off-pump coronary artery bypass grafting (CABG) is superior to "on-pump" CABG in patients requiring coronary interventions remains on-going. In low risk patients, the benefits of off-pump CABG remain unclear. However, there seems to be a benefit in high risk patients. This chapter discusses the potential benefits of off-pump CABG in high risk patients.