On-pump versus off-pump coronary artery bypass graft surgery. What do the evidences show? Revascularização cirúrgica do miocárdio com versus sem circulação extracorpórea. O que mostram as evidências?

Abstract The main purpose of the off-pump coronary artery bypass surgery is to reduce morbidity and mortality due cardiopulmo-nary bypass. However, even though many studies have shown that off-pump coronary artery bypass is feasible and provides hospital morbidity and mortality similar to the on-pump coro-nary artery bypass graft surgery, probably better in some as-pects, its long-term results have been questioned, since some trials have shown reduced survival with off-pump coronary ar-tery bypass. It is likely that incomplete revascularization and/or poor graft patency with off-pump coronary artery bypass prob -ably are responsible for such unfavorable outcome. Descriptors: Myocardial revascularization. Coronary artery by-pass. Coronary artery bypass, off-pump. Evidence-based medicine. Resumo A proposta da revascularizacao do miocardio sem emprego da circulacao extracorporea visa a diminuicao da morbimortalidade decorrente dos potenciais efeitos deleterios da circulacao extracor-porea. Todavia, embora a maioria dos estudos demonstre que a revascularizacao sem circulacao extracorporea e factivel e forneca resultados similares a operacao com circulacao extracorporea, no que se refere a morbimortalidade hospitalar, e pode mesmo dimi-