Coronary revascularization without cardiopulmonary bypass in high-risk patients: A route to the future

Previous reports have demonstrated that reoperative coronary revascularizat ion, advanced age, female sex, and impaired left ventricular dysfunction ar e independent predictors of operative mortality after coronary artery bypas s grafting (CABG). CABG without cardiopulmonary bypass (off-pump CABG) has been proposed as a potential therapeutic alternative in these high-risk pat ient groups. Despite the substantial learning curve associated with off-pum p CABG, early outcomes of off-pump CABG in high-risk patients are better th an those associated with the conventional on-pump CABG approach. These resu lts suggest that off-pump CABG is a safe alternative to on-pump CABG in hig h-risk patients. Randomized prospective studies are needed to validate the results of these initial retrospective reports and to demonstrate the long- term benefits of this approach. (C) 2001 by The Society of Thoracic Surgeon s.