Beware of beating heart CABG : It is minimally invasive and minimally effective !

The NEJM’s breaks the  hidden truths about cardiopulmonary bypass in a beating  heart.The irony in medical science is   ,  trend setting  land mark articles usuallyarrive  very late . . .   to disappoint  all those  patients who  got the wrong treatment !Off pump by pass is definitely one among them . . .

The major reason for off pump CABG’s s poor showing is

• The surgeon’s  conflict   in defining   what is successful CABG  .The success of CABG   is   in    relief of symptoms &providinggood bypass graft  with long term patency   .It is not in  less  thoracic trauma or in  a quick hospital discharge  !
• The second major reason is denial of  the fact  that off pump CABG is indeed inferior  and hence no course correction was attempted  !( And  now that it   has become a hard  evidence   we expect some changes  . It  required almost 10 years for our cardiology community to  recognise this .)
• Lesion access and  difficulty in mobilizing LIMA .Many times the the point of anastomoses is preselected by the accessibility and technical issues rather than lesion guided approach .This often happens than we imagine , and this could be a very bad advertisement for off  pump CABG

Click on the link to NEJM abstract  ROOBY study

http://content.nejm.org/cgi/content/short/361/19/1827