TY - CHAP M1 - Book, Section TI - Myocardial Revascularization Without Cardiopulmonary Bypass A1 - Yanagawa, Bobby A1 - Halkos, Michael E. A1 - Puskas, John D. A2 - Cohn, Lawrence H. A2 - Adams, David H. Y1 - 2017 N1 - T2 - Cardiac Surgery in the Adult, 5e AB - Despite the increased prevalence of percutaneous coronary intervention (PCI) to treat coronary disease, coronary artery bypass graft (CABG) will continue to have a major role, particularly in patients with complex multivessel disease and diabetes mellitus. Currently, the majority of surgical revascularization is performed with the use of cardiopulmonary bypass (CPB), with most surgeons preferring to perform distal anastomoses on an arrested heart. Advocates of this approach cite low morbidity and mortality with outcomes that have continued to improve despite a surgical patient population with increasing comorbid conditions and more advanced and severe coronary disease.1-3 However, complications, albeit infrequent, continue to plague a small percentage of patients undergoing CABG including stroke, renal failure, and respiratory failure. These complications occur not only because of the systemic inflammatory activation that occurs with extracorporeal circulation, but also because of the manipulation of the aorta required for cannulation, CPB, and aortic clamping. The interest in off-pump techniques was largely driven by the increased awareness of the deleterious effects of CPB and aortic manipulation. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1144152233 ER -