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• W1971531437 abstract "We welcome Yasir Abu-Omar and David Taggart's review of coronary artery bypass grafting (CABG; July 27, p 327);1Abu-Omar Y Taggart DP Off-pump coronary artery bypass grafting.Lancet. 2002; 360: 327-329Summary Full Text Full Text PDF PubMed Scopus (42) Google Scholar it adds to the strong evidence that low-risk populations are the best candidates for off-pump CABG. They rightly highlight two randomised trials, both of which show reduced postoperative morbidity and length of hospital stay in low-risk patients who underwent CABG with an off-pump technique. The lower organ dysfunction achieved with off-pump CABG has been ascribed to the fact that a systemic inflammatory response is avoided with the cardiopulmonary bypass circuit.2Salerno TA Ricci M Karamanoukian HL Beating heart coronary artery surgery. Futura Publishing Company, Armonk, NY2001Google Scholar Several points, however, need to be emphasised about the development of off-pump CABG. Off-pump CABG is reaching its so-called tipping point.3Karamanoukian HL D'Ancona G What is the “tipping point” for the acceptance of new technologies in cardiac surgery.http://www.hsforum.com/vol5/issue2/2002-2202.htmlGoogle Scholar Although 80% of all beating heart coronary operations are done by 20% of cardiac surgeons, many more surgeons could adopt this surgical strategy.3Karamanoukian HL D'Ancona G What is the “tipping point” for the acceptance of new technologies in cardiac surgery.http://www.hsforum.com/vol5/issue2/2002-2202.htmlGoogle Scholar More than 500 retrospective analyses show that, despite a higher risk profile, patients who have undergone off-pump CABG have significantly improved outcomes compared with patients who have had CABG by cardiopulmonary bypass.2Salerno TA Ricci M Karamanoukian HL Beating heart coronary artery surgery. Futura Publishing Company, Armonk, NY2001Google Scholar In its infancy, off-pump CABG was mostly used for coronary revascularisation in high-risk patients.4D'Ancona G Karamanoukian HL Soltoski P Salerno TA Bergsland J Changing referral patterns in off-pump coronary artery bypass surgery: a strategy for improving surgical results.Heart Surg Forum. 1999; 2: 246-249PubMed Google Scholar Despite this bias in referral patterns, off-pump CABG resulted in excellent outcomes in most series with reduced morbidity and mortality in repeat CABG.5Cleveland JC Shroyer AL Chen AY et al.Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity.Ann Thorac Surg. 2001; 72: 1282-1289Summary Full Text Full Text PDF PubMed Scopus (407) Google Scholar Abu-Omar and Taggart's review is refreshing because it reminds both the cardiologist and the cardiac surgeon that off-pump CABG is equally beneficial in low-risk patients. However, until randomised trials of off-pump CABG in high-risk patients are undertaken, we must continue to rely on data from retrospective analyses that indicate an improved outcome with off-pump CABG for this specific population. In the meantime, cardiac surgery is “tipping” towards off-pump CABG." @default.
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• W1971531437 date "2002-12-01" @default.
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• W1971531437 title "Off-pump coronary artery bypass grafting in low-risk patients" @default.
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