The majority of CABG procedures are done via the on-pump method (ONCAB), where a cardioplegic solution is used to stop the heart and the patient’s circulatory system is temporarily maintained through the use of a cardiopulmonary bypass (CPB). Additionally, the CABG procedure can be performed via the off-pump technique (OPCAB), where the surgery is performed on the beating heart without the use of CPB.

CABG Procedure Trends

Because the use of a CPB pump for circulation exposes the patient’s blood to foreign surfaces, the ONCAB technique has been shown to increase the incidence of bleeding and short-term neurocognitive defects, known as a postperfusion syndrome (PPS) or “pump head.” Symptoms of PPS are subtle and include defects associated with attention, concentration, short-term memory, and fine motor function.

Additionally, stopping the heart during surgery and clamping of the aorta has been shown to release thrombogenic agents that may result in strokes. These negative drawbacks to performing ONCAB procedures have encouraged more surgeons to switch to off-pump and minimally invasive techniques when performing CABG procedures.

However, the majority of physicians still prefer the ONCAB method. The recent US cardiac surgery market study found that, in 2019, approximately 15.8% of total CABG procedures were performed using OPCAB, while the remainder of surgeons chose the ONCAB method. Because OPCAB requires additional training, many cardiac surgeons, particularly of the older generation, are still reluctant to switch from risker ONCAB techniques.

An alternate method for coronary vascularization that had been rising in popularity is percutaneous coronary intervention (PCI), previously known as angioplasty. PCI procedures absolve patients from the risk of PPS associated with ONCAB, and surgeons from the inherent procedural difficulties with performing OPCAB. Thus, advancements in PCI technology are expected to be a major contributor to a decline in total CABG procedures.

CABG Procedure Forecast

Although the overall decrease in CABG procedures will be mitigated by the aging U.S. population, the net change in the number of annual CABG procedures is still forecasted to be negative. The close relationship between procedure volumes and unit sales of CABG-related devices will trigger a decrease in the value of the U.S. market for both ONCAB and OPCAB devices.

From a Global perspective, the number of CABG procedures was reduced in 2020 as an effect of the COVID-19 pandemic. However, the number of  CABG procedures should rapidly increase in 2021 as restrictions and vaccinations ease the pandemic effects. Nevertheless, the overall trend for global CABG procedure numbers are expected to remain relatively constant over the next 5 years despite the aging global population.

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