الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Off-pump CABG is increasingly attracting the attention of surgeons due to the increased aging population with expected increase incidence of heavily atheromatous aorta. The safety and long-term efficacy are still a matter of debate, particularly as it is majorly dependent on the experience of surgeon, his convenience with the intervention and the availability of assisting devices to ease the potentially challenging procedure. Major part of the rising popularity of the procedure is the relatively better short-term outcomes and avoidance of the hazardous impacts of the cardiopulmonary bypass machine.
Aim of the work
This study aimed to compare the early outcomes of on-pump CABG versus off-pump in terms of: number of anastomosed vessels, duration of mechanical ventilation, duration of ICU admission, postoperative bleeding, incidence of atrial fibrillation, acute kidney injury and neurological complication and mortality.
Patients and methods
First encountered eligible patients were included and the choice of procedure was merely the surgeon’s own preference. Eighty patients were distributed equally in two groups based on the type of revascularization approach. Off-pump CABG surgery was performed by one surgeon who has a good experience with the off-pump surgery.
Results
In this study, the short-term outcomes of the off-pump CABG were significantly better in terms of bleeding, duration of ICU admission and mechanical ventilation. However, the number of completed grafts was significantly less than those in on-pump group. The incidence of postoperative adverse postoperative events namely; atrial fibrillation, acute kidney injury and neurological complications were not statistically significant between the two groups.
Conclusion
The argument surrounding the potential advantages and safety of the off-pump is difficult to be settled with the available to-date trials and meta-analyses. The debate will progress as conflicting results are being continually released from different studies which are unavoidably biased. A long follow-up monitoring is crucial, yet not achieved in the current literature. With only observational data available, results are heavily biased and unreliable. The off-pump surgery is now being reborn with massive development and innovations. The clampless, total arterial conduits and anaortic technique aided with HeartString device is a promising approach that is currently being applied to minimize the risk of thromboembolism in calcified aorta. Unfortunately, the success of this technique is highly dependent on the presence of well-trained personnel and is not applicable in all centers. Despite the non-ending debate and argument, it can be safely concluded that there is a consensus that in such clinical situation where aorta is densely atheromatic, surgeons must definitely consider the off-pump surgery. With the expectant rise in the incidence of coronary disease, some institutions should make wise and long-term plans to assign and train teams to be dedicated to perform off-pump surgeries. The methodology of this surgery and the ongoing development is challenging to acquire in the absence of well-established training program and large case volumes. This raises the importance of subspecialty in coronary surgery. This is supported by evidence from studies showing similar results of both techniques in centers with high case volume and well-experienced surgeons