Assessment of hemodynamic stability in patients undergoing off-pump versus on-pump coronary artery bypass grafting: a systematic review of clinical results
Year: 2025
Type: review
Study design: Systematic Review
Abstract: This systematic review evaluates hemodynamic stability and postoperative outcomes in patients undergoing coronary artery bypass grafting (CABG) performed with or without cardiopulmonary bypass (CPB). On-pump CABG, which utilizes CPB, provides a stable, bloodless surgical field that facilitates precise revascularization and is often preferred in complex cases requiring multiple grafts. However, it is associated with increased risks of complications, including stroke, renal dysfunction, and systemic inflammation caused by exposure to the extracorporeal circuit. Conversely, off-pump CABG is performed on a beating heart, eliminating the need for CPB and reducing perioperative risks such as renal dysfunction, stroke, and prolonged recovery times. While this approach promotes faster recovery and is particularly beneficial for high-risk patients, it is also associated with limitations, including incomplete revascularization and a higher likelihood of graft failure, which may necessitate future interventions. The review included studies published between 2014 and 2024, identified through searches in SciELO, PubMed, and MEDLINE databases, and analyzed using predefined inclusion and exclusion criteria. A total of 24 studies were initially reviewed, with 10 meeting the final inclusion criteria. Findings reveal that both techniques offer distinct advantages and disadvantages depending on patient-specific factors. Off-pump CABG demonstrated significant benefits for patients with pre-existing renal impairment, reducing mortality rates and postoperative dialysis requirements. However, this technique's challenges in achieving complete revascularization have raised concerns about long-term outcomes, including higher rates of repeat interventions and mortality. On the other hand, on-pump CABG provided more reliable long-term results, particularly in achieving complete revascularization, but at the cost of increased perioperative risks, including neurological and renal complications. The studies reviewed highlight that the choice of surgical technique should be highly individualized, taking into account patient-specific risks, comorbidities, and clinical goals. This review underscores the importance of balancing the benefits and limitations of each approach to optimize outcomes and emphasizes the need for further research into improving techniques and long-term results in both methods.
Source: Caderno Pedagógico
Authors: Maria Eduarda Corrêa Piquet Gonçalves, Lara Campos Lima Ferraz, Bruna Campos Carvalho, Maria Eduarda Beleza Cabral de Vasconcelos, Mariana Araújo Honorato, Maria Eduarda de Lima Cabral, Sylvia Ferreira Grisi Paiva, Eduardo Eugênio Miranda Alencar, Maria Luiza Lacerda Ferraz, Maria Cecília Cesar Correia de Farias, Lara Casimiro Britto, Beatriz Serpa Vieira, Paulo André Jordão de Paiva Serpa, Ramiro Becker Filho, Ana Luiza Padilha Brito
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4406171105