Off-Pump Coronary Artery Bypass Grafting in Senegal: Initial Experience from a Tertiary Cardiovascular Center

Background: Off-pump coronary artery bypass (OPCAB) is a surgical alternative to conventional coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB), offering early benefits in terms of reduced morbidity and faster recovery. However, its use remains limited in sub-Saharan Africa due to insufficient access to technical equipment, despite its lower overall cost compared to on-pump surgery. Objective: To assess the feasibility and immediate outcomes of OPCAB surgery in a resource-limited African setting. Methods: A retrospective review was conducted on four consecutive patients with symptomatic triple-vessel coronary artery disease who underwent OPCAB between January and November 2025. Median sternotomy, Maquet® stabilizers, intraluminal coronary shunts, and arterial and venous grafts were used. Perioperative and short-term postoperative outcomes were analyzed. Results: The mean patient age was 54.8 years. Comorbidities included hypertension (100%), type 2 diabetes (75%), and dyslipidemia (100%). Eleven distal anastomoses were performed, averaging 2.75 per patient. No conversion to cardiopulmonary bypass was required. One patient experienced a non-fatal myocardial infarction postoperatively; others had uneventful recoveries. All patients were discharged after an average hospital stay of 9 days and remained asymptomatic at 2-month follow-up. Conclusion: OPCAB surgery is feasible and safe in a sub-Saharan African tertiary center, even in a high-risk population. This technique offers promise as a cost-effective alternative to on-pump bypass in low-resource environments, pending appropriate training and basic surgical infrastructure.