Off-pump versus on-pump coronary artery bypass grafting—a surreal controversy?

© 2018, Indian Association of Cardiovascular-Thoracic Surgeons. As per the findings of the SYNTAX Trial, it has been established that coronary artery bypass grafting (CABG) affords the best long-term results in patients with multivessel disease. However, it is still a point of contention whether ‘off-pump’ CABG (OPCAB) (on cardiopulmonary bypass) is better. Many studies appear to establish the superiority of one or the other. But there is still no well-planned multi-centre randomised controlled trial looking into all aspects of the issue that can, once and for all, put the controversy to rest. But as long as one is able to give the patient a good result, does it really matter whether the procedure is done off or on pump? This article looks at the available evidence with regard to various parameters comparing OPCAB and conventional CABG in an attempt to answer the question, if at all, it is a question!