Off-pump coronary artery bypass grafting

Current evidence on the safety and efficacy of off-pump coronary artery bypass grafting (CABG) is adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance, consent and audit.

During the consent process, patients should be informed that they will be offered off-pump CABG rather than on-pump surgery, but that on-pump surgery may be a possibility. They should be informed about the uncertainties in relation to longer-term risks of graft occlusion and mortality, as well as the likely advantages of off-pump CABG, including the lower incidence of stroke.

Patient selection and treatment should be carried out by cardiac surgical teams who are skilled in both off-pump and on-pump surgery.

The National Institute for Cardiovascular Outcomes Research runs the UK Central Cardiac Audit Database (UKCCAD) and NICE encourages clinicians to submit data on patients having off-pump CABG to the database, with a view to ultimately providing information about longer-term outcomes by linking the database to national statistics records.