Abstract
Although popularised over two decades ago off-pump coronary artery bypass grafting (OPCABG) has seen a decrease in utilisation especially over the last decade. This has been due to publication of a number of trials which suggested inferior outcomes with OPCABG. However, the validity of the findings in these trials has been questioned on the basis of doubts over operator experience as witnessed by large numbers of cross-overs. Two more recent large randomised trials have shown very similar outcomes between on and off-pump surgery up to 1- and 5-year outcomes are imminently due. Furthermore several meta-analyses have reported that OPCABG reduces mortality, myocardial infarction and major morbidity in higher risk patients. Consequently there is a clear rationale for OPCABG in certain cohorts of patients and especially when combined with a no touch aortic technique in those with significant disease of the ascending aorta. The article discusses the importance of routine performance of OPCABG if it is to produce high quality results and especially in higher risk patients.