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Review
. 2006 Nov;22(13):1107-10.
doi: 10.1016/s0828-282x(06)70945-x.

Off-pump coronary artery bypass graft surgery is standard of care: where do you stand?

Jean-Francois Légaré  1 , Gregory Hirsch
Affiliations
Review

Off-pump coronary artery bypass graft surgery is standard of care: where do you stand?

Jean-Francois Légaré et al. Can J Cardiol. 2006 Nov.

Abstract
in English, French

The cardiopulmonary bypass (CPB) has allowed the establishment of coronary artery bypass graft surgery (CABG) to be a safe and effective treatment for patients with ischemic heart disease. However, the concern that CPB may be responsible for CABG-related morbidity has been raised, and it has been suggested that CABG itself would be safer without CPB. The development of commercially available cardiac stabilization devices resulted in several large, nonrandomized retrospective case series. The studies demonstrated that CABG can be performed safely without CPB (off-pump surgery), and suggested that there are benefits compared with conventional CABG. However, the randomized controlled studies published to date have been, as a whole, unable to conclusively demonstrate advantages of off-pump CABG. The results of these randomized studies are likely responsible for the failure of off-pump CABG to become established as the standard of care.

La circulation extracorporelle (CEC) a permis de rendre sûrs et efficaces les pontages coronariens chez les patients souffrant d’une cardiopathie ischémique. Toutefois, certains ont soulevé la question de savoir si la CEC pouvait, à elle seule, accroître la morbidité liée au pontage, et on est allé jusqu’à dire que le pontage lui-même serait plus sûr sans la CEC. La commercialisation de nombreux dispositifs d’immobilisation du cœur a donné lieu à plusieurs grandes séries de cas rétrospectifs, non répartis au hasard. D’après les études, le pontage coronarien sans CEC, c’est-à-dire à cœur battant, peut être pratiqué en toute sécurité, et cette façon de faire comporterait des avantages par rapport au pontage classique. Cependant, les essais comparatifs, menés avec hasardisation et publiés jusqu’à maintenant n’ont pas réussi à prouver indéniablement les avantages du pontage à cœur battant. C’est probablement en raison des résultats de ces essais avec répartition aléatoire que le pontage à cœur battant n’est pas parvenu à s’imposer comme norme de soins.

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