Off‐pump, minimally invasive and robotic coronary revascularization yield improved outcomes over traditional on‐pump CABG

Abstract

Coronary artery disease is a global health concern, with increasing morbidity and mortality. Surgical coronary artery bypass grafting has been performed on cardiopulmonary bypass for nearly four decades, with excellent long-term durability. Beating-heart coronary surgery has been increasing in frequency in an attempt to decrease cardiopulmonary bypass-related morbidity. Furthermore, with increasing expertise and technology, minimally invasive and robotic techniques have been developed to enhance postoperative recovery, patient satisfaction and cosmesis. Several clinical trials have demonstrated decreased morbidity and more rapid recovery following off-pump, minimally invasive and robotic procedures when compared to on-pump coronary artery bypass grafts (CABGs). An equivalent extent of revascularization and medium-term anastomotic patency has been demonstrated among all approaches. Furthermore, for a large number of patients who do not have anatomy amenable to traditional coronary revascularization, adjunctive molecular therapies may provide alternative myocardial micro-revascularization.

Hydroxyethyl starch 6%, 130/0.4 vs. a balanced crystalloid solution in cardiopulmonary bypass priming: a randomized, prospective study

“…Coronary bypass surgery is the most frequently performed cardiac operation worldwide and modifications are made in order to maintain more reasonable results [3]. Various improvements are recorded on surgical techniques, CPB devices, drugs and perioperative management.…”

The Golden Age of Minimally Invasive Cardiothoracic Surgery: Current and Future Perspectives

“…The first MIDCABs were usually performed through anterolateral thoracotomies and without CPB, also referred to as off-pump coronary artery bypass (OPCAB) [55]. OPCAB can be applied to MIDCAB or traditional full sternotomy procedures.…”

“…Studies comparing MIDCAB versus traditional CABG using full sternotomy have suggested such favorable results for the MIDCAB patient, including shorter hospital length of stay, earlier return to baseline physical activity and reduced transfusion requirements [65–67]. Long-term graft patency using MIDCAB has been preliminarily shown to be excellent [55]. …”

Exercise Training for Patients After Coronary Artery Bypass Grafting Surgery

“…In addition, with increasing expertise and technology, minimally invasive and robotic techniques have been developed to enhance post-operative recovery and patient satisfaction. 47 However, there is no study compare the effect of exercise training on conventional CABG and those new techniques, further study is needed to evaluate the difference between conventional and new surgical techniques to the outcomes in patients with CABG.…”