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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Anesthetic Considerations in Off-Pump Coronary Artery Bypass Grafting: A Narrative Review

  • Gentian Huti1
  • Artan Jahollari2
  • Asead Abdyli1
  • Rudin Domi1,3
  • Driola Hoxha1
  • Besnik Filaj1
  • Oliatina Demiri1
  • Ervisa Abdyli1
  • Daniele Biasucci4
  • Filadelfo Coniglione4
  • Fabio Guarracino5
  • Vojislava Neskovic6
4 more authors
  • Idit Matot7
  • Krenar Lilaj3
  • Vedat Eljezi8
  • Anne-Marie Camilleri-Podesta9
9 affiliations
  1. 1Department of Anesthesia and Intensive Care Medicine, American Hospital 3, Tirana 1005, Albania
  2. 2Department of Cardiovascular Surgery, American Hospital 3, Tirana 1005, Albania
  3. 3Department of Surgery, University of Medicine, Tirana 1005, Albania
  4. 4Department of Clinical Science and Translational Medicine, ‘Tor Vergata’ University of Rome, 00133 Rome, Italy
  5. 5Department of Medical, Dental and Biotechnological Sciences, University Gabriele d’Annunzio Chieti-Pescara, Anesthesia, Resuscitation and Intensive Care, University Hospital of Chieti, 66100 Chieti, Italy
  6. 6Clinic for Anesthesia and Critical Care, Military Medical Academy, Faculty of Medicine MMA, 11040 Belgrade, Serbia
  7. 7Division of Anesthesiology, Intensive Care and Pain, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
  8. 8Department of Perioperative Medicine, CHU Gabriel-Montpied, 63003 Clermont-Ferrand, France
  9. 9Department of Anesthesia and Intensive Care, Mater Dei Hospital, MSD 2090 Msida, Malta
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Abstract

Background: Off-pump coronary artery bypass grafting (OPCAB) avoids cardiopulmonary bypass (CPB) and may reduce selected perioperative complications, but its technical and hemodynamic demands remain important limitations. Methods: We narratively reviewed the literature indexed in PubMed/MEDLINE and Scopus, supplemented by Google Scholar and reference-list screening, covering January 2000 to August 2026. Priority was given to systematic reviews, meta-analyses, randomized trials, prospective studies, guidelines, and relevant landmark reports. Results: OPCAB may be particularly useful in selected patients at increased risk from CPB or aortic manipulation. Cardiac displacement and coronary stabilization can cause rapid changes in preload, ventricular function, myocardial perfusion, and cardiac output, making invasive monitoring, transesophageal echocardiography, and coordinated hemodynamic management central to anesthetic care. Current evidence does not establish the superiority of volatile anesthesia or total intravenous anesthesia. Comparative studies suggest potential reductions in perioperative stroke, transfusion, renal complications, and hospital stay, although potential stroke benefits depend on the aortic-handling strategy and should not be attributed to avoidance of CPB alone. Concerns remain regarding completeness of revascularization, graft durability, repeat revascularization, and long-term survival. Conclusions: OPCAB should be considered an individualized strategy rather than a universal alternative to on-pump CABG. Optimal outcomes depend on patient selection, surgical expertise, vigilant monitoring, and timely correction of hemodynamic compromise. Potential neurological benefits should be interpreted in relation to the aortic-handling strategy, particularly when an anaortic/no-touch technique is used.

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Cite

BibTeXRIS
BibTeX
@article{huti2026anesthetic,
  title = {{Anesthetic Considerations in Off-Pump Coronary Artery Bypass Grafting: A Narrative Review}},
  author = {Gentian Huti and Artan Jahollari and Asead Abdyli and Rudin Domi and Driola Hoxha and Besnik Filaj and Oliatina Demiri and Ervisa Abdyli and Daniele Biasucci and Filadelfo Coniglione and Fabio Guarracino and Vojislava Neskovic and Idit Matot and Krenar Lilaj and Vedat Eljezi and Anne-Marie Camilleri-Podesta},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15218499},
  url = {https://www.mdpi.com/2077-0383/15/21/8499},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Anesthetic Considerations in Off-Pump Coronary Artery Bypass Grafting: A Narrative Review
AU  - Gentian Huti
AU  - Artan Jahollari
AU  - Asead Abdyli
AU  - Rudin Domi
AU  - Driola Hoxha
AU  - Besnik Filaj
AU  - Oliatina Demiri
AU  - Ervisa Abdyli
AU  - Daniele Biasucci
AU  - Filadelfo Coniglione
AU  - Fabio Guarracino
AU  - Vojislava Neskovic
AU  - Idit Matot
AU  - Krenar Lilaj
AU  - Vedat Eljezi
AU  - Anne-Marie Camilleri-Podesta
PY  - 2026
DA  - 2026/11/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218499
UR  - https://www.mdpi.com/2077-0383/15/21/8499
AB  - Background: Off-pump coronary artery bypass grafting (OPCAB) avoids cardiopulmonary bypass (CPB) and may reduce selected perioperative complications, but its technical and hemodynamic demands remain important limitations. Methods: We narratively reviewed the literature indexed in PubMed/MEDLINE and Scopus, supplemented by Google Scholar and reference-list screening, covering January 2000 to August 2026. Priority was given to systematic reviews, meta-analyses, randomized trials, prospective studies, guidelines, and relevant landmark reports. Results: OPCAB may be particularly useful in selected patients at increased risk from CPB or aortic manipulation. Cardiac displacement and coronary stabilization can cause rapid changes in preload, ventricular function, myocardial perfusion, and cardiac output, making invasive monitoring, transesophageal echocardiography, and coordinated hemodynamic management central to anesthetic care. Current evidence does not establish the superiority of volatile anesthesia or total intravenous anesthesia. Comparative studies suggest potential reductions in perioperative stroke, transfusion, renal complications, and hospital stay, although potential stroke benefits depend on the aortic-handling strategy and should not be attributed to avoidance of CPB alone. Concerns remain regarding completeness of revascularization, graft durability, repeat revascularization, and long-term survival. Conclusions: OPCAB should be considered an individualized strategy rather than a universal alternative to on-pump CABG. Optimal outcomes depend on patient selection, surgical expertise, vigilant monitoring, and timely correction of hemodynamic compromise. Potential neurological benefits should be interpreted in relation to the aortic-handling strategy, particularly when an anaortic/no-touch technique is used.
SN  - 2077-0383
ER  -