On-Pump Beating Myocardial Revascularization in Patients with Acute Coronary Syndrome

Document Type : Original Article


Department of Cardiovascular surgery, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: The on-pump beating heart technique for myocardial revascularization with a normothermic Cardiopulmonary bypass (CPB) represents a combination of standard on-pump and off-pump bypass techniques. The purpose of our study was to evaluate the outcome of patients with acute coronary syndrome undergoing on-pump beating coronary artery bypass grafting (CABG).
Methods: Between February 2020 and February 2021, 125 consecutive patients with acute coronary syndrome requiring coronary revascularization and not candidate for primary angioplasty or thrombolytic therapy, underwent on-pump beating myocardial revascularization. In this cohort study the primary inclusion criteria were the persistence of coronary artery disease (CAD) suitable for CABG and acute coronary syndrome. Our outcome variables included all-cause mortality, low cardiac output state, arrhythmia, postoperative myocardial infarction (MI), respiratory failure, stroke, ICU and total hospital stay.
Results: Mean age of patients was 59.11±9.81 years (range 33–84 years) and 68% of patients were male. Preoperative mean left ventricular ejection fraction was 43.61 ± 9.61 % (range 10-60 %) which improved to 46.71±8.41% postoperatively (p=0.010). The average number of graft per patient was 2.91±0.71 and complete revascularization was performed in 119 patients (95.2%). Mean ICU stay of patients was 2.11±1.41 (range 1–12) and mean hospital stay of patients was 6.11 ± 3.71 (range 5–15). Three patients (2.4%) died during recovery in the ICU due to acute cardiac failure.
Conclusion: On-pump beating CABG (OPBCABG) is an effective strategy with improved hospital outcome and can be a good alternative to conventional CABG and off-pump cardiac bypass surgery in acute coronary syndrome (ACS).


  1. Trachiotis GD, Weintraub WS, Johnston TS, Jones EL, Guyton RA, Craver JM. Coronary artery bypass grafting in patients with advanced left ventricular dysfunction. The Annals of thoracic surgery. 1998 Nov 1;66(5):1632-9.
  2. Salehi M, Bakhshandeh A, Rahmanian M, Saberi K, Kahrom M, Sobhanian K. Coronary artery bypass grafting in patients with advanced left ventricular dysfunction: excellent early outcome with improved ejection fraction. The Journal of Tehran University Heart Center. 2016 Jan 1;11(1):6.
  3. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Straka Z, et al. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. New England journal of medicine. 2016 Dec 15;375(24):2359-68.
  4. Wang B, Cheng Z, Ge Z, Peng B, Zhao Z, Quan X. Level of perioperative B-type natriuretic peptide associates with heart function after on-pump coronary artery bypass graft surgery on a beating heart. Pakistan Journal of Medical Sciences. 2015 Mar;31(2):379.
  5. Fudulu D, Benedetto U, Pecchinenda GG, Chivasso P, Bruno VD, Rapetto F, et al. Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials. Journal of thoracic disease. 2016 Nov;8(Suppl 10):S758.
  6. Pegg TJ, Selvanayagam JB, Francis JM, Karamitsos TD, Maunsell Z, Yu LM, et al. A randomized trial of on-pump beating heart and conventional cardioplegic arrest in coronary artery bypass surgery patients with impaired left ventricular function using cardiac magnetic resonance imaging and biochemical markers. Circulation. 2008 Nov 18;118(21):2130-8.
  7. Ferrari E, Stalder N, von Segesser LK. On-pump beating heart coronary surgery for high risk patients requiring emergency multiple coronary artery bypass grafting. Journal of Cardiothoracic Surgery. 2008 Dec;3(1):1-6.
  8. Bergsland J, Hasnan S, Lewin AN, Bhayana J, Lajos TZ, Salerno TA. Coronary artery bypass grafting without cardiopulmonary bypass-an attractive alternative in high risk patients. European journal of cardio-thoracic surgery. 1997 May 1;11(5):876-80.
  9. Cartier R, Brann S, Dagenais F, Martineau R, Couturier A. Systematic off-pump coronary artery revascularization in multivessel disease: experience of three hundred cases. The Journal of Thoracic and Cardiovascular Surgery. 2000 Feb 1;119(2):221-9.
  10. Darwazah AK, Bader V, Isleem I, Helwa K. Myocardial revascularization using on-pump beating heart among patients with left ventricular dysfunction. Journal of Cardiothoracic Surgery. 2010 Dec;5(1):1-6.
  11. Darwazah AK. Abu Sham ‘a RA, Hussein E, Hawri MH, Ismail H. Myocardial revascularization in patients with low ejection fraction< or= 35%: effect of pump technique on early morbidity and mortality. J Card Surg. 2006;21:22-7.
  12. Perrault LP, Menasché P, Peynet J, Faris B, Bel A, de Chaumaray T, Gatecel C, Touchot B, Bloch G, Moalic JM. On-pump, beating-heart coronary artery operations in high-risk patients: an acceptable trade-off?. The Annals of thoracic surgery. 1997 Nov 1;64(5):1368-73.
  13. Rastan AJ, Bittner HB, Gummert JF, Walther T, Schewick CV, Girdauskas E, et al. On-pump beating heart versus off-pump coronary artery bypass surgery—evidence of pump-induced myocardial injury. European journal of cardio-thoracic surgery. 2005 Jun 1;27(6):1057-64.
  14. Kirklin JK. Prospects for understanding and eliminating the deleterious effects of cardiopulmonary bypass. The Annals of thoracic surgery. 1991;51(4):529-31.
  15. Ascione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. The Annals of thoracic surgery. 2000 Apr 1;69(4):1198-204.
  16. Gaudino M, Glieca F, Alessandrini F, Nasso G, Pragliola C, Luciani N, et al. High risk coronary artery bypass patient: incidence, surgical strategies, and results. The Annals of thoracic surgery. 2004 Feb 1;77(2):574-9.
  17. Légaré JF, Buth KJ, King S, Wood J, Sullivan JA, Friesen CH, et al. Coronary bypass surgery performed off pump does not result in lower in-hospital morbidity than coronary artery bypass grafting performed on pump. Circulation. 2004 Feb 24;109(7):887-92.
  18. Ascione R, Caputo M, Angelini GD. Off-pump coronary artery bypass grafting: not a flash in the pan. The Annals of thoracic surgery. 2003 Jan 1;75(1):306-13.
  19. Diegeler A, Börgermann J, Kappert U, Breuer M, Böning A, Ursulescu A, et al. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. New England journal of medicine. 2013 Mar 28;368(13):1189-98.
  20. Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. New England Journal of Medicine. 2012 Apr 19;366(16):1489-97.
  21. Taggart DP, Altman DG, Gray AM, Lees B, Nugara F, Yu LM, et al. Effects of on-pump and off-pump surgery in the Arterial Revascularization Trial. European Journal of Cardio-Thoracic Surgery. 2015 Jun 1;47(6):1059-65.
  22. Wan IY, Arifi AA, Wan S, Yip JH, Sihoe AD, Thung KH, et al. Beating heart revascularization with or without cardiopulmonary bypass: evaluation of inflammatory response in a prospective randomized study. The Journal of thoracic and cardiovascular surgery. 2004 Jun 1;127(6):1624-31.
  23. Prifti E, Bonacchi M, Giunti G, Frati G, Proietti P, Leacche M, et al. Does on‐pump/beating‐heart coronary artery bypass grafting offer better outcome in end‐stage coronary artery disease patients?. Journal of cardiac surgery. 2000 Nov;15(6):403-10.
  24. Ascione R, Reeves BC, Taylor FC, Seehra HK, Angelini GD. Beating heart against cardioplegic arrest studies (BHACAS 1 and 2): quality of life at mid-term follow-up in two randomised controlled trials. European heart journal. 2004 May 1;25(9):765-70.
  25. Afrasiabirad A, Safaie N, Montazergaem H. On-pump beating coronary artery bypass in high risk coronary patients. Iranian Journal of Medical Sciences. 2015 Jan;40(1):40.
  26. Miyahara K, Matsuura A, Takemura H, Saito S, Sawaki S, Yoshioka T, et al. On-pump beating-heart coronary artery bypass grafting after acute myocardial infarction has lower mortality and morbidity. The Journal of thoracic and cardiovascular surgery. 2008 Mar 1;135(3):521-6.