**Author details**

tive heart failure, calcified aortic disease, and renal failure. It was seen that the standard CABG group as compared to OPCAB group had higher rates of stroke (2.0% vs. 1.6%), high‐ er bleeding complications (2.2% vs. 1.6%), and prolonged hospital stay by one day. At 3-year follow-up, the need for repeat revascularization was also greater in standard CABG versus

In another retrospective study by Mack et al in which 17401 patients were reviewed and 7283 received OPCAB, it was found that even in patients with PAD among other risk fac‐ tors, patients undergoing OPCAB had improved mortality when compared to patients un‐ dergoing on-pump CABG (1.9% vs. 3.5%). The rate of complications including major bleeding, wound infection, atrial fibrillation, permanent stroke, gastrointestinal and respira‐ tory complications, renal failure, myocardial infarction, and multiorgan failure was higher

In another study comprising 214 patients at high risk (high EuroSCORE) with >50% of pa‐ tients with significant PAD, it was found that off-pump CABG was safer and was associated

Patients with PAD are likely to have complex atheromatous plaques in the arch of aorta which poses a risk for peri-operative stroke during manipulation for on-pump CABG sur‐ gery An analysis of 422 patients demonstrated that there was a significant reduction in postoperative stroke in patients who had OPCAB when compared to patients undergoing onpump surgery (0.9% vs. 5.7%, p=0.007) [83]. Therefore, for patients with PAD needing CABG, OPCAB would help avoid manipulation of aorta and in turn, decrease post-opera‐

Over a period of time, an increasing body of evidence has indicated that OPCAB is better than on-pump CABG, especially in high-risk groups. This includes a significant benefit of OPCAB in patients with PAD as it reduces the risk of postoperative stroke. As it has been shown in the SYNTAX trial, which is the largest contemporary trial comparing PCI versus CABG, showed that the major risk with CABG appears to be the increased risk of stroke from it [84]. OPCAB can, at least reduce that chance which might improve the overall bene‐

Based on current data, there is sufficient evidence to suggest that diabetes, peripheral arteri‐ al disease, CKD, on-pump CABG, increased aortic cross clamp and cardiopulmonary bypass duration, lack of use of IMA graft are strongly associated with poor in hospital, short term and long term outcomes after CABG. Rigorous modification of these risk factors to the maxi‐ mum possible extent preoperatively can result in further improvement of surgical outcomes

with less early post-operative complications including multi-organ failure [82].

the OPCAB group [80].

452 Artery Bypass

in standard CABG group [81].

tive cerebrovascular complications.

fit of CABG in patients with advanced CAD.

**4. Conclusion**

following CABG.

Muhammad A. Chaudhry1 , Zainab Omar2 and Faisal Latif3

