The choice of on- or off-pump coronary bypass grafting--a surgeon's dilemma

Off-pump coronary bypass grafting (OPCAB) is a routine method of heart revascularization. This study was designed to compare the results of OPCAB and ONCAB performed by a single surgeon at our institution over a 3-year period. The study enrolled 345 patients undergoing elective myocardial revascularization procedures, of which 173 (50.1%) were OPCAB and 172 (49.9 %) were ONCAB. The postoperative outcomes of both groups were analyzed, retrospectively. The mean number of grafts was significantly lower in the OPCAB group (2.9) than in the ONCAB group (3.7). There were no postoperative myocardial infarctions or hospital deaths in any of the patients. The postoperative total blood loss was significantly higher in the ONCAB group. The frequencies of postoperative confused states, strokes, postoperative transfusions, reoperations for bleeding, and atrial fibrillation, and the durations of intubation, ICU stay, and hospital stay did not differ significantly between the two groups. The OPCAB procedures are safe and provide good clinical outcomes, similar to those of ONCAB operations. The outcomes of this study favor neither of the compared techniques.