Important question: answer should be that we should use the right tool for the right job. Issues include, but not limited to, the technical quality of distal anastomoses (and related patency), number of grafts (commonly less with OPCAB), reduction of symptoms, and long-term survival.
http://www.sciencedirect.com/science/article/pii/S0022522314001846
http://www.jtcvsonline.org/article/S0022-5223(14)01329-4/abstract
I believe that off-pump CABG is superior to on-pump CABG in experienced heart- teams and also total arterial revascularization is an important issue in long-term follow-up.
I have been doing OPCAB's since about 8 years and started my trainig with OPCAB's. I think one has to be dedicated to do so and keep on going, especially with right numbers. The evidence against OPCAB is coming a bit up, that is true, on the other hand the design of the studies is not every time the best, there is much bias in it. Probably, studies done with dedicated OPCAb surgeons would provide us with different results.
On pump. Very occasional LIMA LAD off.
Never felt comfortable doing off pump. I like a reserve parachute.
I'm doing all CABG only off pump. No limitation number of grafts. I don't use nor starfish neither deep stich.
Currently I am doing my cases on pump. There was a time period between 2001 to 2006 when I did both on and off pump surgery. But there was no evidence that off pump surgery was superior in patient outcome. With potential risk of less than satisfactory anastomosis with off pump surgery , I reverted back to on pump surgery.
During last 15 years I am doing all coronary cases on beating heart. My ezperience is
a little bit less than 2000 operations. I am absolutely convienced in priority of OPCAB surgery as many of my colleagues .
Prof. Toomas Suiling does off pump even in redo cases. He is excellent surgeon.
I am skeptical of any surgeon who does anything the same way 100% of the time.
All coronary surgeons should have ability to do an OPCAB, especially when faced with a calcified aorta or poor patient protoplasm. However, there is no compulsion (nor robust data) to support abandoning conventional CABG in favour of OPCAB.
We go to the OR with our toolbox and should use whichever tool works best in our hands.
Dear Darshan, I feel really sorry for your sceptisism! You probably did not get the reality, that 100% off-pump surgeons are able to do without any troubles the on-pump CABG as well, but the on-pump surgeons do not the vice versa. Addtitionally, I don't know in your institution, but we have still a lot of combined procedures (MVR+CABG, AVR+CABG,..) where we do anyway on-pump CABG!!! Take car, Tomas
Thanks Tomas, you've just proven my point! There is no such thing as 100% off pump surgery, because every now and then we all need that pump...
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