Off Pump Coronary Surgery (OPCAB) and the Evolution of My Pragmatism!

I have been observing and then performing coronary artery surgery since 1988. It was in 1992 when I first heard of Subramanian's first published accounts of LIMA to LAD coronary bypass done off pump i.e. without the aid of a heart lung machine.

The Pragmatic Cardiac Surgeon.

Off-Pump or On-Pump Coronary-Artery Bypass Grafting at 30 Days — NEJM
 This randomised trial compared 30 day outcomes between patients whose coronary bypass operation was done with a heart lung machine with those whose surgery was performed without i.e. OPCAB - Off Pump Coronary Bypass. 

ANOTHER NAIL IN THE OPCAB COFFIN

Three-year follow-up in a subset of high-risk patients randomly assigned to off-pump versus on-pump coronary artery bypass surgery: the Best Bypass Surgery Trial -- Møller et al. 97 (11): 907 -- Heart

This study provides some more evidence for the non-inferiority and probably superiority of on pump coronary surgery when to compared to off pump CABG in higher risk patients.