Yoo Kyung-Jong
Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Chest Surg. 2025 Jul 5;58(4):121-133. doi: 10.5090/jcs.24.122. Epub 2025 Apr 15.
The evolution of treatment for ischemic heart disease has been driven by advancements in both diagnostic and therapeutic methods, including coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). Initially, CABG relied on on-pump techniques using saphenous vein grafts; however, off-pump coronary artery bypass grafting (OPCAB) emerged as an alternative to reduce complications associated with cardiopulmonary bypass. Despite potential benefits-such as a reduced risk of stroke, shorter hospital stays, and fewer respiratory and renal complications-OPCAB has seen limited adoption, particularly in Western countries, owing to its technical demands and concerns regarding graft patency and complete revascularization. Large-scale randomized trials have reported mixed results, with outcomes strongly influenced by surgeon experience and patient selection. In contrast, smaller studies by experienced surgeons have demonstrated comparable graft patency and superior outcomes in high-risk patients. Recent meta-analyses underscore the need for total arterial revascularization and no-touch aortic techniques to further optimize OPCAB results, particularly in high-risk populations. Moving forward, OPCAB shows significant promise for patients with severe comorbidities, such as those with calcified aortas or poor ventricular function. Enhanced training programs and hybrid revascularization strategies that integrate minimally invasive CABG with PCI could further expand OPCAB adoption. By leveraging its unique strengths-including reduced postoperative complications and improved outcomes for high-risk patients-OPCAB could play a pivotal role in modern cardiac surgery. To remain competitive with PCI, surgeons must actively prepare for OPCAB by developing expertise in both techniques tailored to the patient's clinical condition.
缺血性心脏病治疗方法的演变受到诊断和治疗方法进步的推动，包括冠状动脉造影、经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）。最初，CABG依靠使用大隐静脉移植物的体外循环技术；然而，非体外循环冠状动脉旁路移植术（OPCAB）作为一种替代方法出现，以减少与体外循环相关的并发症。尽管有潜在益处，如中风风险降低、住院时间缩短以及呼吸和肾脏并发症减少，但由于其技术要求以及对移植物通畅性和完全血运重建的担忧，OPCAB的采用率有限，尤其是在西方国家。大规模随机试验报告的结果不一，结果受到外科医生经验和患者选择的强烈影响。相比之下，经验丰富的外科医生进行的较小规模研究表明，在高危患者中移植物通畅性相当且结果更佳。最近的荟萃分析强调需要进行全动脉血运重建和非接触主动脉技术，以进一步优化OPCAB的结果，尤其是在高危人群中。展望未来，OPCAB对患有严重合并症的患者，如主动脉钙化或心室功能差的患者，显示出巨大的前景。加强培训计划以及将微创CABG与PCI相结合的混合血运重建策略可以进一步扩大OPCAB的应用。通过利用其独特优势，包括减少术后并发症和改善高危患者的结果，OPCAB可以在现代心脏手术中发挥关键作用。为了与PCI竞争，外科医生必须通过发展针对患者临床状况的两种技术的专业知识，积极为OPCAB做好准备。
