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Heart, Lung and Circulation

On and Off Pump: The Marriage of Opposites With Potential Long-Term Rewards

      There are at least three different methods of surgical coronary revascularisation—on-pump with an arrested heart, on-pump without arrest of the heart, and off-pump surgery. The on-pump beating (ONBEAT) coronary bypass surgery embodies an amalgamation of conventional on-pump coronary surgery (CABG) and off-pump technique (OPCAB). The principal benefits emerging from the ONBEAT technique are the avoidance of cardioplegic arrest and the haemodynamic stability ensured throughout the procedure, notably in unstable high-risk patients. In this Issue of Heart, Lung and Circulation, the study by Zhu et al. reports the Australian clinical experience with the on-pump beating heart coronary surgery for emergency multiple myocardial revascularisation — the ONBEAT methods led to both good short-term and good long-term survival, although no better than conventional CABG in this retrospective, propensity-matched database study [
      • Zhu M.Z.L.
      • Huq M.M.
      • Billah B.M.
      • Tran L.
      • Reid C.M.
      • Varatharajah K.
      • et al.
      On-pump beating versus conventional coronary artery bypass grafting early after myocardial infarction: a propensity-score matached analysis from the ANZSCTS database.
      ].

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