Bypass operation at the beating heart in comparison to the operation with support of the heart-lung machine

The coronary Bypass operation at the beating heart ("off-pump surgery") is a new procedure which promises advantages in comparison to the established procedure with uses a heart-lung machine ("on-pump-surgery"). In the presented HTA report cardiac surgery the question is investigated, whether there are advantages of the off-pump-surgery in comparison to the on-pump-surgery regarding medical effectiveness, safety as well as cost effectiveness. At the beginning a systematic literature search was done, the articles were classified according to the hierarchy of evidence. There are partly considerable different groups of patients included in the different studies as well as quite different outcome parameters. The quality of the studies in detail, where at least two groups are compared was generally very good. The studies results show more or less equivalent results in the comparison of the two operation techniques. Concluding neither a clinical superiority nor an inferiority on the basis of the present available studies can therefore be proven (off-pump Coronary Artery Bypass; OPCAB) or the conventional bypass operation with use of the heart-lung machine (Coronary Artery Bypass Graft; CABG can). The diagnostic criteria of a patient who is allocated to the one or other operating technique are important. Due to technical reasons the majority of patients with the necessity of a bypass operation con only be treated by CABG, (on-pump-surgery). These criteria for the allocation of operation techniques should be the important components of optimization considerations.