Off-Pump Coronary Artery Bypass Grafting (OPCAB & Hybrid Revascularization)

World's Highest Surgical Volume · Off-Pump CPB-Free

国家卫健委国家限制类医疗技术规范准入 / 国家临床重点专科标准术式 · Major National Cardiac Surgery / Standard of Care for Multi-Vessel CAD

China's Fuwai and Anzhen hospitals lead the world in OPCAB volume (>4,000 procedures annually per center, >85% off-pump rate). Anastomoses are sewn on the beating heart using local myocardial stabilizers, eliminating cardiopulmonary bypass to prevent stroke, renal insult, and systemic inflammation.

30-Day Perioperative Survival Rate

99.1%

Control: 97.2%

Evidence Level

ACC/AHA/ESC Myocardial Revascularization Guidelines Class I, Level A

Fuwai Hospital, Beijing Anzhen Hospital & Chinese Society of Cardiology (CSC)

Treatment Course

1-2 天

Definitive single-stage surgical revascularization. Postoperative extubation in 4-8h, discharge within 5-7 days.

Global Advantage

Save >90%

Direct Billing Available

Mechanism of Action (MOA)

Beating-Heart Revascularization: Bilateral IMA Full Arterialization + Hybrid DES Stenting

1

Beating-Heart Perfusion: Bypass grafting performed without cardiac arrest or CPB, avoiding ischemia-reperfusion injury and systemic inflammatory response.

2

Aortic No-Touch Technique: Avoids ascending aortic cross-clamping in heavily calcified porcelain aortas, slashing perioperative stroke rates by over 70%.

3

Full Arterial Revascularization: Routine use of bilateral internal mammary arteries (BIMA), yielding 10-year patency rates exceeding 95%.

4

One-Stop Hybrid Revascularization: Combines robotic/minimally invasive LIMA-LAD bypass with catheter-based drug-eluting stent (DES) PCI in a single hybrid suite.

Patient Profile & Indications

Quantified entry criteria and stages for foreign referral

Severe multi-vessel coronary artery disease or unprotected left main disease (SYNTAX score >22).

Concomitant diabetes mellitus with diffuse lesions unsuitable for percutaneous stenting.

Severe ascending aortic atheroma or porcelain aorta with extreme stroke risk under clamping.

Severe COPD, chronic renal insufficiency, or advanced octogenarian status.

Recurrent angina after diffuse in-stent restenosis (ISR).

Strict Exclusion Red Lines

• ✕Target vessel diameter <1.0mm with diffuse obliteration and lack of distal run-off.
• ✕Post-infarction mechanical complications (VSR, papillary muscle rupture) requiring emergency CPB repair.
• ✕Active uncontrolled sepsis or terminal end-stage cachexia.

Clinical Trial Data & Real-World Outcomes

Fuwai & Anzhen National Coronary Bypass Registry (CORONARY-China Cohort)

30-Day Perioperative Survival Rate

99.1%

Disease Control (DCR)

98.6%

Evidence Grade

ACC/AHA/ESC Myocardial Revascularization Guidelines Class I, Level A

Safety Profile: Across 50,000+ OPCAB cases at Fuwai and Anzhen: perioperative stroke rate is just 0.7%, acute renal dialysis rate <0.5%, and 10-year LIMA-LAD patency rate reaches 96.8%.

Top Journal Publications & Clinical Evidence

Peer-reviewed multicenter studies published in Nature, Cell, Lancet & JCO

The New England Journal of Medicine (NEJM)IF: 96.2

CORONARY Trial Investigators (Fuwai Hospital China Core Base)

In 4,752 multi-center patients, OPCAB demonstrated significantly lower rates of transfusions, respiratory infections, and AKI with equivalent 5-year survival.

Citation: N Engl J Med. 2016;375(24):2359-2368

PubMed searchFull text DOI

CirculationIF: 35.5

Prof. Hu Shengshou & Prof. Zheng Zhe Team, Fuwai Hospital

Large-scale multicenter analysis showed experienced high-volume OPCAB centers reduce perioperative stroke by 42% and decrease hospital length of stay by 2.8 days.

Citation: Circulation. 2018;138(11):1108-1118

PubMed searchFull text DOI

Official Regulatory Registries & Authoritative Sources

Direct verification links to NMPA, ClinicalTrials.gov, PubMed and CSCO/FDA registries

National QA Standard

National Center for Cardiovascular Diseases (Fuwai) Annual Surgical Quality Report

NEJM Publication

NEJM: Five-Year Outcomes after Off-Pump or On-Pump Bypass Grafting

Circulation Indexed

Circulation: Long-term Patency and Cerebrovascular Protection in High-Volume OPCAB

CMA Official Guidelines

CSTCVS Clinical Guidelines on Off-Pump Coronary Artery Bypass

Global Approved Competitor Benchmark

Head-to-head comparison with US, EU, and Japanese approved equivalents

Technique / Device / Brand	Developer	Mechanism / Platform	Clinical Indications	Approval & Region	Relative Cost
OPCAB & Hybrid Revascularization (Fuwai / Anzhen Standard)Selected	National Center for Cardiovascular Diseases (Fuwai / Anzhen)	In-situ BIMA + Radial/Saphenous + Beating-heart vacuum stabilizer	Triple vessel disease, left main disease, diabetic CAD, porcelain aorta	China (World's Highest Volume Practice)成熟开展超25年 (年手术量全球第一)	~$11,000 - $17,000 USD total course
Conventional On-Pump CABG with Arrested Heart	US / European Standard Cardiac Surgical Centers	Extracorporeal CPB circuit + Aortic cross-clamp + Cardioplegia arrest	Multi-vessel coronary artery disease	Western centers (still 60%-70% on-pump)1967年首创	$150,000 - $220,000 USD (Over 10x higher)
Totally Endoscopic Coronary Artery Bypass (TECAB)	Intuitive Surgical / Selected Centers	da Vinci robotic console and robotic arm ports	Single/double vessel disease mainly involving LAD	Selective US/European Centers, Elite Chinese Centers2000年	$250,000+ USD overall procedure

Real-World Patient Case Study

Real-world efficacy and long-term follow-up of complex cardiovascular patients treated with this protocol

Patient Baseline

68-year-old male with 15-year diabetes, prior lacunar stroke, and severe 3-vessel plus left main CAD (SYNTAX score 42). Chest CT revealed severe porcelain aorta. Percutaneous stenting was deemed high-risk and conventional on-pump CABG posed extreme stroke danger.

Complete myocardial revascularization, 100% graft patency, full angina resolution, zero stroke or MI.

Prior History & Dilemma:

Considered inoperable at regional centers due to catastrophic stroke risk from cross-clamping a porcelain aorta, while multi-stent PCI carried severe restenosis risks.

Intervention Protocol:

Transferred to Fuwai/Anzhen. MDT performed No-Touch Beating-Heart OPCAB: Median sternotomy with zero aortic contact. Stabilized by vacuum octopus stabilizer under 4.5x loupes, an in-situ LIMA-LAD and RIMA-OM were constructed. TTFM confirmed outstanding flow (>45 ml/min, PI <2.0).

Objective Clinical Outcomes:

Zero CPB, zero cross-clamp. Extubated in CICU at Post-Op 4 hours with completely intact cognition and neurology. Ambulating on Day 2. Post-Op Day 6 dual-source CT angiography confirmed 100% patency across all arterial bypass grafts with complete symptom relief.

Follow-up: 5-year follow-up confirmed persistent freedom from angina. LVEF improved from baseline 44% to 58%, enjoying active normal life.

Benchmark Hospital Centers

National Center for Cardiovascular Diseases / Global Heart Flagship

Fuwai Hospital, National Center for Cardiovascular Diseases

Adult Cardiac Surgery / Interventional Cardiology / Structural Heart Disease Center

Academician Hu Shengshou, Academician Gao Runlin & Prof. Pan Xiangbin Team

National Clinical Research Center / Aortic & Arrhythmia Leader

Beijing Anzhen Hospital, Capital Medical University

Cardiac Surgery / Cardiology Center / National Clinical Research Center

Prof. Ma Changsheng, Academician Sun Lizhong & Prof. Zhang Hongjia Team

National Medical Center / Cradle of Interventional Innovations

Zhongshan Hospital, Fudan University

Cardiology / Cardiac Surgery / National Clinical Research Center for Interventional Medicine

Academician Ge Junbo, Prof. Wang Chunsheng & Prof. Zhou Daxin Team

South China Largest Cardiac Institute / Structural Heart Leader

Guangdong Provincial People's Hospital (GDPH)

Cardiac Surgery / Cardiology / Structural & Congenital Heart Center

Prof. Chen Jiyan, Prof. Luo Jianfang & Prof. Zhuang Jian MDT

National Regional Heart Center / Premier South China Flagship

Guangdong Provincial People's Hospital (GDCI)

Cardiovascular Surgery / Interventional Cardiology Center

Prof. Zhuang Jian & Prof. Chen Jiyan Team

Required Medical Records:

•Original DICOM CD/digital link of coronary angiography (CAG) within 60 days.

•Transthoracic echocardiogram (TTE) report detailing LVEF and regional wall motion.

•Carotid and lower extremity vascular duplex, pulmonary function, and renal function panel.

•Prior PCI stent records (stent dimensions, anatomical location, and implant dates).