There are several prospectively randomized trials and a recently published meta-analysis, either in progress or recently completed, that attempt to definitively answer some of these questions. Parolari et al5–
performed a meta-analysis of all randomized trials of OPCAB vs CABG from 1990 to 2002. They found nine comparable trials (peer reviewed, prospective, and randomized) with a total of 1,090 patients (CABG, 558 patients; OPCAB, 532 patients). Using a composite end point of death, stroke, or myocardial infarction, there was a trend toward reduction in risk (odds ratio, 0.48; p = 0.08) in patients in the OPCAB groups but no clear benefit. Most of the studies were from Europe, and four of the studies had the same author. Another carefully performed and statistically robust study6–
comparing OPCAB with CABG also suggested improved clinical outcomes with OPCAB. In particular, this conclusion may apply to important subgroups of patients (eg, octogenarians).7
have found no difference in outcomes referable to the technique chosen, and one article10
simply concluded by saying that patients undergoing OPCAB are not exposed to a greater risk of short-term adverse outcomes.