Complications related to off-pump bypass grafting.

Surgical myocardial revascularization is a technique undergoing critical reevaluation in an attempt to reduce operative morbidity and mortality. As the age and number of comorbidities in the surgical population presenting for bypass increases, improved strategies to lessen operative risk have evolved. The use of off-pump bypass grafting to avoid the detrimental effects of extracorporeal circulation demonstrates great promise in reducing operative complications. However, with new techniques come new challenges. Avoidance of the cardiopulmonary bypass circuit has been linked to the development of a hypercoagulable state postoperatively. Complications related to the unique management of the ascending aorta and target vessels during the performance of beating heart surgery are also being reported. Moreover, despite increasing experience in a number of centers, hemodynamic collapse does occur during off-pump bypass, thereby requiring rapid institution of cardiopulmonary bypass. Continued scientific investigation and research should provide the tools to manage the unique obstacles encountered with off-pump coronary artery bypass.