Whether myocardial revascularization should be performed with or without the use of cardiopulmonary bypass, referred to as off-pump and on-pump CABG, is still up for debate. Intuitively, avoidance of cardiopulmonary bypass seems beneficial, as the systemic inflammatory response from extracorporeal circulation is omitted. Even so, no single randomized trial has been able to prove that off-pump CABG is superior to on-pump CABG, as regards the hard outcomes of death, stroke or myocardial infarction.

Nowadays, Off-pump coronary artery bypass grafting (OPCAB) has become a common practice for coronary artery bypass grafting (CABG). Also, it seems that organ dysfunctions (liver, kidney, bowel ischemia, stroke and other kinds of minor dysfunctions) should be definitively differentiated, considering the two myocardial revascularization operations. A limitation associated with the off-pump technique, namely hemodynamic instability, concerns the quality of the anastomosis, the ability to achieve complete revascularization and the on-pump conversion rate, constituting speculative concerns. Therefore, it is still unclear whether OPCAB is superior in terms of graft patency, the incidence of complications, long-term outcomes, and the associated mortality rate- compared with conventional CABG (CCABG).

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