What is the difference between "off pump" and "on pump" coronary artery bypass grafting (CABG)?

Updated: Dec 04, 2019
  • Author: Rohit Shahani, MD, MS, MCh; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

The initial CABGs in the 1960s were performed “off pump” (OPCABG) because of the lack of cardiopulmonary bypass technology. [44] With the subsequent development of safe and effective cardiopulmonary bypass, most CABGs are now performed “on pump” (ONCABG). However, the off-pump approach has been reintroduced, with varying degrees of popularity, in an effort to reduce the complications associated with cardiopulmonary bypass. The surgical experience of the operating surgeons performing the OPCABG is critical to the outcome of the procedure. In a Cochrane review that analyzed 86 randomized trials involving 10,716 patients, Moller and colleagues reported that OPCABG resulted in increased all-cause mortality compared to ONCABG (3.7% vs 3.1%; P = 0.04), but there were no significant differences in MI, stroke, renal insufficiency, or coronary artery reintervention between the two techniques other than that OPCABG resulted in fever distal anastomoses. [45]

Elderly patients who have major comorbid conditions (eg, previous stroke or TIA; peripheral vascular disease [PVD]; bleeding disorders; or current respiratory, liver, or renal disease) may benefit from an off-pump approach. The off-pump approach may also be preferred in patients with a heavily calcified or atheromatous aorta, where cannulation is associated with a high risk of stroke. [46]


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