Abstract

SWOT ANALYSIS OF ON-PUMP AND OFF-PUMP CORONARY ARTERY BYPASS GRAFTING SURGERY

Mubassera Shaikh, Parloop Bhatt* and Kishor Gupta

ABSTRACT

Coronary artery bypass graft (CABG) surgery is performed on patients with complex cardiovascular disease. There are two basic ways of performing CABG: on pump CABG (ONCABG) and off pump CABG (OFCABG). Off pump CABG is a comparative newer procedure which does not require use of the cardiopulmonary bypass machine while on pump CABG is considered a traditional approach. Although many meta-analyses and randomized control trials have compared both the techniques, controversies surrounds the benefits and specificities of each. This review article analyzes- the strengths, weaknesses, opportunities and threats (SWOT analysis) of both the techniques. On-pump approach may be considered better for emergency procedures and in cardiogenic shock condition while off pump is safe, effective, feasible with lower post-operative morbidity and mortality; superior in elderly and severe aortic atherosclerotic disease. On pump CABG offers better revascularization and lower recurrence of angina in comparison to off pump CABG however on pump triggers renal dysfunction, gastrointestinal distress, and cardiac defects. Long term outcomes infer not much of difference in mortality and repeat revascularization between ONCABG and OFCABG. Opting for either on/off pump CABG also depends on the surgeon's ease of performing the procedure since it impacts the outcomes.

Keywords: SWOT analysis, CABG, off pump, On pump.