Strategic forces influencing the adoption of off-pump coronary artery bypass grafting

Despite increasing competition from percutaneous interventions and other novel methods of non-surgical coronary revascularization, coronary artery bypass grafting (CABG) remains one of the most definitive and durable treatments for coronary artery disease, especially for patients with extensive and diffuse disease. In recent years the CABG procedure itself has undergone innovation and evolution. Off-pump coronary artery bypass (OPCAB) grafting is one such innovation. The available evidence from a large number of randomized clinical trials, nonrandomized clinical trials, propensity-matched analyses, and experimental data suggests that outcomes are comparable between off-pump and on-pump CABG and that OPCAB may have disctinct advantages for specific patient populations, but skepticism still exists about the safety and efficacy of the off-pump technique, preventing universal adoption of OPCAB grafting. This chapter examines the strategic forces influencing the adoption of off-pump, limited-access, and robotic-assisted CABG.