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1 Duhaylongsod F. Minimally invasive cardiac surgery defined. Arch Surg 2000;135:296-301.

2 Roach G, Kanchuger M, Mangano C, et al. Adverse cerebral outcomes after coronary bypass surgery. N EnglJ Med 1996;335:1857-63.

C Observational study reporting the frequency of permanent stroke and transient neurologic dysfunction after conventional bypass surgery. The paper indirectly puts into perspective the potential role of off-pump bypass surgery.

3 Eagle K, Guyton R, Davidoff R, et al. ACC/AHA guidelines for coronary artery bypass graft surgery. J Am Coll Cardiol 1999;34:1262-347.

C Extensive report and summary of the American Heart

Association/American College of Cardiology guidelines on bypass surgery: history, complications, outcome, and determinants.

4 Arom K, Flavin Th, Emery R, et al. Safety and efficacy of off-pump coronary artery bypass grafting. Ann Thorac Surg 2000;69:704-10.

C Retrospective analysis of the immediate outcome of 350 patients treated in a single centre. Patients were stratified into three risk groups. The clinical information in combination with the discussion provides insights into the potential role of off-pump bypass surgery.

5 Mark D, Newman M. Protecting the brain in coronary artery bypass graft surgery. JAMA 2002;287:1448-50.

6 Edmunds L. Why cardiopulmonary bypass makes patients sick: strategies to control the blood-synthetic surface interface. Adv Cardiac Surg 1995;6:131-67.

C Landmark paper on the role of cardiopulmonary bypass in the perioperative morbidity, providing insight into the pathophysiology and, thus, potential solutions.

7 Ascione R, Lloyd C, Underwood M, et al. On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg 1999;68:493-8.

C Small randomised clinical trial assessing the changes in renal function after off- and on-pump surgery. The protective effects of off-pump surgery are demonstrated.

8 Borst C, Jansen E, Tulleken C, et al. Coronary artery bypass grafting without cardiopulmonary bypass and without interruption of native coronary flow using a novel anastomosis site restraining device ("Octopus"). J Am Coll Cardiol 1996;27:1356-64.

C Experimental study in a pig model explaining the function of the Octopus tissue stabiliser and the histologic effects on the myocardium after application.

9 Stanbridge R, Hadjinikolaou L. Technical adjuncts in beating heart surgery. Comparison of MIDCAB to off-pump sternotomy: a meta-analysis. Eur J Cardiothorac Surg 1999;16(suppl 2):S24-33.

10 Grundeman P, Borst C, van Herwaarden J, et al. Hemodynamic changes during displacement of the beating heart by the Utrecht Octopus method. Ann Thorac Surg 1997;63:S898-92.

► Experimental study disclosing the potential adverse haemodynamic effects during the manipulation of the heart during off-pump bypass surgery—a problem which can be adequately addressed but may still limit the use of off-pump bypass surgery.

11 Van Dijk D, Nierich A, Jansen E, et al. Early outcome after off-pump versus on-pump coronary bypass surgery. Results from a randomized study. Circulation 2001;104:1761-6.

► First multicentre randomised clinical trial comparing off- and on-pump bypass surgery. Detailed surgical data and clinical outcome at 30 days are reported.

12 Van Dijk D, Jansen E, Hijman R, et al. Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery. A randomized trial. JAMA 2002;287:1405-12.

► Multicentre randomised clinical trial comparing off- and on-pump bypass surgery. Neurologic outcome and detailed information on neurocognitive dysfunction and outcome at three months are reported.

13 Ascione R, Lloyd CT, Gomes WJ, et al. Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized study. Eur J Cardiothorac Surg 1999;15:685-90.

► Small, single centre, randomised clinical trial assessing the protective effects of off-pump bypass surgery in comparison to on-pump surgery on myocardial cell damage and loss.

14 Kilger E, Pichler B, Weis F, et al. Markers of myocardial ischemia after minimally invasive and conventional coronary operation. Ann Thorac Surg 2000;70:2023-8.

► Non-randomised study assessing the course of the serum markers of myocardial tissue damage during off- and on-pump surgery through various routes of cardiac access. Off-pump surgery is associated with less injury in comparison with on-pump surgery.

15 MackM, Osborne J, Shennib H. Arterial graft patency in coronary artery bypass grafting: what do we really know? Ann Thorac Surg 1998;66:1055-59.

16 Mack M, Magovern J, Acuff T, et al. Results of graft patency by immediate angiography in minimally invasive coronary artery surgery. Ann Thorac Surg 1999;68:383-90.

► A prospective, observational study reporting graft patency after LIMA insertion on the left anterior descending artery during off-pump surgery.

17 Hart J, Spooner T, Pym J, et al. A review of 1,582 consecutive Octopus off-pump coronary bypass patients. Ann Thorac Surg 2000;70:1017-20.

► A succinct and concise summary of the clinical outcome of a large series of patients who underwent off-pump bypass surgery with the Octopus method in seven centres in the USA and Europe.

18 Hernandez F, Cohn W, Baribeau Y, et al. In-hospital outcomes of off-pump versus on-pump coronary artery bypass procedures: a multicenter experience. Ann Thorac Surg 2001;72:1528-34.

► Indirect comparison of the in-hospital outcome between 1741 patients who underwent off-pump bypass surgery with 6126 patients who underwent conventional bypass surgery in four centres of the Northern New England Cardiovascular Disease Study Group.

19 Puskas J, Thourani V, Marshall J, et al. Clinical outcomes, angiographic patency and resource utilisation in 200 consecutive off-pump coronary bypass patients. Ann Thorac Surg 2001;71:1477-84.

Additional references appear on the Heart

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