Changing the Discussion about On-Pump Versus Off-Pump CABG

The performance of coronary-artery bypass grafting (CABG) without the use of the heart–lung machine (pump) was introduced to avoid the damaging effects of cardiopulmonary bypass. On-pump CABG with cardiopulmonary bypass is generally performed on an arrested heart, and off-pump CABG on a beating heart, without cardiopulmonary bypass. Off-pump CABG became popular in the 1990s, peaking at just under 25% of the CABG operations performed in the United States in 2002; the rate then plateaued and has been slowly declining. Some surgeons remain enthusiasts, whereas others have never attempted it; many use it selectively.