Objective: The ongoing controversy regarding coronary surgery as to perform with or without using cardiopulmonary bypass has not come to a definite conclusion with quite difference between Indian and western scenario. Our objective was to perform a single center, single surgeon prospective observational study to compare clinical outcomes and graft patency in off-pump versus on-pump coronary artery bypass surgery (CABG), to evaluate the current perspective of Indian scenario.

Method: 100 patients were selected and divided into two groups, 50 patients in each group. All surgical planning and patient management were standardized for both groups. Various preoperative demographics, intraoperative variables and postoperative outcomes were measured and compared. After one year, follow-up computed tomography (CT) coronary angiography was done to evaluate the graft patency in all patients of both the groups.

Results: The number of grafts performed per patient was higher in on-pump group, (3.3 vs. 2.7) however the index of completeness of revascularization was similar in both groups. (96.5% vs. 94%, p = NS). There were significant increase in re-explorations, bleeding, transfusions and hospital stay in on pump group. At one-year follow-up, 64 patients underwent CT coronary angiography. 67 of 86 grafts (77.90%) were in off pump group as compared with 86 of 110 grafts (78.1%) in on pump group were patent. All occluded grafts were saphenous vein conduits to coronary targets other than left anterior descending (LAD) territory.

Conclusion: Off pump CABG can provide complete durable and cost effective revascularization comparable with on pump CABG when performed in well experienced hand without compromising completeness of revascularization.