The aging of the population, together with the increasing prevalence of arteriosclerosis and diabetes, means that coronary surgery remains one of the mainstays of cardiac surgery today. The eternal debate on the best option for revascularization of a patient with ischemic heart disease, using stents or open surgery, maintains a large group of patients with very clear indications for each technique. In the intermediate zone is where decisions become more complex, because although surgery offers better long-term results, it is also true that it is initially more aggressive for a patient. Off-pump coronary surgery fills the gap of offering the stable results of conventional surgery, with less physiological aggression.
In the 1990’s, the concept of beating heart surgery was revived with the technical difficulties that this entailed, but technological advances and the standardization of methods meant that this type of surgery was consolidated in leading hospitals. Added to the effect of using arterial grafts to achieve complete revascularization without the need for veins, the results began to gain ground over more classical techniques. By avoiding side effects of extracorporeal circulation, patients have less complicated postoperative periods, although the final results in terms of safety are similar.
Thus, Cardiovascular Surgery Services have developed in which this technique has been incorporated as a standard technique for coronary surgery. The advantage of this is that a high percentage of their patients are done off-pump, maintaining a small group of conventional surgery for unsuitable cases. Thus, the training of the surgeon and the team is optimal for the performance of this technique and it is precisely the most complex patients who benefit most from these effects.
There is no doubt at present that coronary artery surgery done well, both on-pump and off-pump, offers superior results to catheterization/stenting in truncal, multivessel and diabetic disease. The advantage of a surgical team familiar with off-pump coronary artery bypass grafting (OPCABG) is that it can also offer a lower complication rate in complex patients.
Usually, the general strategy is to perform off-pump coronary surgery electively, checking the tolerability of the procedure during the surgical procedure itself and deciding to stop the heart in unstable cases. The percentage of off-pump surgery is 85-90%.