It's important to look at everything! I agree that Op-Cabs have a place in certain Patient populations generally Pts with vessels that are easy to get to on top of the heart and those with heavily calcified aortas, but this technology is not the panacea that ISMICS portrays. I have seen Pts severely struggle with arrhythmias and BP drops that even border on arrests and even actual arrests with MI's that have to crash on CPB because the surgeon wants to prove that he can do these types of procedures. (Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial)
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15691685 Everyone knows that it is easier to sew on a bloodless motionless target than to make a patient that is already very sick work 2-3 times as hard and literally struggle for there life while they torque the heart up and out of the chest so they can visualize the intended target for grafting. There are certain surgeons that do this type of procedure all the time and they are very good at it, and they should be the ones doing it! but those surgeons that only dabble in this type of extremely invasive procedure should not!
The height of this technology has already peaked a few years ago at the mid 20% range of cases being done and is now on the way down to the mid teens nationally.
Technically it is a better operation to be done on pump and more grafts are done on CPB that stay open longer than off pump. Think of it this way, how many times are they going to be inside your chest in your lifetime? wouldn't you want them to do the most that they could with the best possible grafts while your heart was rested or would you rather have them do less grafts on a moving target with blood in the field and make you struggle for your life when you are the most compromised. Conventional CPB grafting with a standard sternotomy has an overall mortality rate of 2% nationally, nothing else even comes close.