Off-pump or On-pump? Single-vessel Coronary Artery Bypass Grafting Surgery

Objectives: Off-pump coronary artery bypass grafting (OPCAB) was introduced to avoid the adverse effects of cardiopulmonary bypass used in on-pump coronary artery bypass grafting (ONCAB). While OPCAB is performed on a beating heart, often in a more challenging surgical field, ONCAB provides a stable, bloodless environment with the heart arrested. Despite extensive research comparing the two techniques, consensus on the optimal approach, particularly for single-vessel disease, remains unclear. Single-vessel disease accounts for approximately 3% of coronary bypass cases, with surgical intervention often preferred for proximal left anterior descending artery (LAD) lesions. Methods: A total of 336 patients aged 20–80 who underwent elective or emergency LAD bypass between 2015 and 2021 were included in the study. Patients were divided into OPCAB (n=125) and ONCAB (n=211) groups. Exclusion criteria included concomitant surgeries, prior cardiac surgery, endarterectomy, non-LAD single-vessel bypass, redo surgeries, hemodynamic instability, and severe arrhythmias. Pre-operative (age, gender, ejection fraction [EF], diabetes, chronic kidney disease), intraoperative (use of left internal mammary artery), and post-operative outcomes (drainage, transfusions, complications, intensive care unit (ICU)/hospital stay, 30- day mortality) were analyzed. Emergency cases included unstable angina or myocardial infarction, while elective cases involved stable coronary disease. Results: Results indicated that the OPCAB group had older patients with lower EFs. There were no significant differences in post-operative complications or mortality rates between the two groups, although OPCAB patients experienced shorter ICU and hospital stays. Importantly, OPCAB demonstrated comparable effectiveness to ONCAB, particularly in older patients and those with lower EFs. Factors influencing mortality included new-onset cerebrovascular accidents and acute renal failure. Conclusion: This study contributes to the limited literature on single-vessel disease and suggests that OPCAB should be considered the first choice in suitable patients due to its reliability and potential benefits. Further research is encouraged to explore these findings in a broader context.