Related Experiment Videos
Off or on bypass: what is the safety threshold?
A L Iacò1, M Contini, G Teodori
1Department of Cardiology and Cardiac Surgery, G. D'Annunzio University of Chieti, Italy.
Insights
Coronary artery bypass grafting without cardiopulmonary bypass (CPB) in selected patients leads to fewer complications and shorter hospital stays. Mortality and stroke rates remain similar compared to traditional CPB methods.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Background:
- Assessing the technical profile of patients undergoing coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB).
- Evaluating the benefits and outcomes of off-pump CABG compared to conventional on-pump procedures.
Purpose of the Study:
- To identify patient characteristics suitable for off-pump CABG.
- To compare the safety and efficacy of CABG with and without CPB.
Main Methods:
- A retrospective analysis of 785 patients undergoing CABG between May 1997 and December 1998.
- Patients were divided into groups: off-pump (Group A), on-pump (Group B), and converted (Group C).
- Key outcomes recorded included mortality, cerebrovascular accident (CVA) incidence, and major complications.
Main Results:
- Off-pump CABG patients typically had one- to three-vessel disease.
- Group A demonstrated lower complication rates, reduced intensive care unit (ICU) and hospital stays, and decreased transfusion requirements.
- Mortality and CVA incidence were comparable between off-pump and on-pump groups.
Conclusions:
- Surgical strategy (on-pump vs. off-pump) does not significantly impact primary endpoints but affects secondary outcomes.
- Off-pump CABG is associated with fewer complications, particularly in specific patient subgroups.
- Both surgical techniques yield satisfactory results, with patient selection and surgeon preference guiding the choice.
Background:
To identify the technical profile of the patients operated on without cardiopulmonary bypass (CPB) and the benefit of the procedure.
Methods:
From May 21, 1997, to December 31, 1998, 785 patients had coronary artery bypass grafting through a median sternotomy (group A: 472 without CPB; group B: 290 with CPB; group C: 23 converted). Technical aspects, mortality rate, cerebrovascular accident (CVA) incidence (crude and risk-adjusted), and incidence of major complications were recorded.
Results:
Patients without CPB had mainly one to three grafts and one- or two-vessel disease. Multiple arterial grafting was not a limit, whereas sequential grafting was. Group A had lower complications rates, shorter intensive care unit and postoperative in hospital stays, and lower transfusion rates. Mortality rates and CVA incidence (crude and risk-adjusted) were similar in both groups and in each subgroup considered. In group A, a lower complications rate was present in some patients (aged greater than 70 years, female, with unstable angina). Group C showed higher mortality and complications rates. Failure of revascularization showed no difference between groups.
Conclusions:
Primary endpoints are not affected by the surgical strategy, whereas some of the secondary endpoints are. However, patients in group A experienced fewer complications. Both techniques can give satisfying results and must be applied according to the surgeon's preference.