Off Pump CABG Improves Postoperative Incidence of Coagulopathy Compared with CABG on Pump

Abstract

oronary artery bypass grafting remains the standard treatment for patients with extensive coronary artery disease. Coronary surgery without use of cardiopulmonary bypass avoids the deleterious systemic inflammatory effects of the extracorporeal circuit. However there is an ongoing debate surrounding the clinical outcomes after on-pump versus off-pump coronary artery bypass (ONCAB versus OPCAB) grafting surgery. Despite a large body of evidence, there is an ongoing, controversial debate whether coronary artery bypass graft surgery should be performed with or without extracorporeal circulation. This intense debate is held between two schools of thought: the “pure”, off-pump surgeons and the on- pump surgeons. Historically, the shift towards off-pump coronary artery bypass (OPCAB) grafting was proposed both to reduce the operation cost in developing countries but also to avoid the deleterious effects of the contact of blood with the artificial extracorporeal circuit (i.e., mainly the systemic inflammatory response and coagulopathy). In coronary artery bypass graft surgery (CABG), derangements in hemostasis and an integrated systemic inflammatory responses (SIRs) contribute to bleeding, transfusion requirements, and adverse postoperative complications. The cardiopulmonary bypass (CPB) pump in coronary artery bypass grafting (CABG) has been identified as the culprit of the insult in