Abstract
Coronary artery bypass grafting is a well-established treatment for coronary artery disease, and avoiding cardiopulmonary bypass has attracted attention because of its potential to reduce complications. Japan was an early and extensive adopter of off-pump coronary artery bypass grafting, offering a unique environment to evaluate its outcomes. Using data from the Japanese Cardiovascular Surgery Database, several large-scale observational studies have compared off- and on-pump coronary artery bypass grafting in diverse patient populations. These studies consistently revealed a lower early mortality with the off-pump technique than on-pump, especially in high-risk groups, such as those with severe renal disease or an impaired left ventricular function. However, concerns persist regarding the completeness of revascularization and the higher likelihood of fewer bypass grafts when performing off-pump surgery than on-pump, which may limit the long-term benefits. Analyses focusing on the long-term survival found no definitive advantage of the off-pump strategy, with some evidence suggesting worse outcomes in patients with incomplete revascularization than in others. Furthermore, the experience level of surgeons and hospital procedure volume have emerged as critical factors influencing the success of off-pump surgery, highlighting the importance of technical proficiency. Overall, although the off-pump approach provides meaningful advantages for select high-risk populations, its routine application remains controversial. Future research efforts should target improved selection criteria and broader data integration to establish more definitive conclusions and optimize patient outcomes.
