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Beating heart versus conventional single-vessel reoperative coronary artery bypass
S C Stamou1, A J Pfister, G Dangas
1Department of Surgery, Washington Hospital Center, and MedStar Research Institute, DC 20010, USA.
Insights
Off-pump redo coronary artery bypass grafting (CABG) is safer and leads to better outcomes than on-pump redo CABG. This study found lower morbidity, mortality, and shorter hospital stays for off-pump procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Reoperative coronary artery bypass grafting (CABG) using cardiopulmonary bypass (on-pump) carries higher risks than primary CABG.
- The comparative safety and efficacy of off-pump redo CABG versus on-pump redo CABG remain unclear.
Purpose of the Study:
- To compare the perioperative outcomes of on-pump versus off-pump redo CABG in patients with single-vessel disease.
Main Methods:
- A retrospective comparison of 41 on-pump and 91 off-pump redo CABG patients between April 1992 and July 1999.
- Patient groups were matched for baseline characteristics and risk stratification (Parsonnet scores).
Main Results:
- On-pump redo CABG had significantly higher rates of postoperative transfusions, prolonged ventilation, and atrial fibrillation.
- On-pump redo CABG also resulted in longer hospital stays and a significantly higher in-hospital mortality rate (10% vs. 1%).
Conclusions:
- Off-pump redo CABG for single-vessel disease is a safe alternative to on-pump procedures.
- Off-pump redo CABG is associated with reduced operative morbidity, mortality, and shorter hospital stays compared to on-pump redo CABG.
Background:
Reoperative (redo) coronary artery bypass grafting (CABG) with cardiopulmonary bypass (on-pump) is associated with a higher morbidity and mortality than first-time CABG. It is unknown, however, whether CABG without cardiopulmonary bypass (off-pump) may yield an improved clinical outcome over conventional on-pump redo CABG.
Methods:
We compared the perioperative outcomes of patients with single-vessel disease who underwent on-pump (n = 41) versus off-pump (n = 91) redo CABG between April 1992 and July 1999. The two groups were similar with respect to baseline characteristics and risk stratification: mean Parsonnet scores were 26 +/- 9 for on-pump versus 24 +/- 8 for off-pump patients (p = nonsignificant).
Results:
On-pump redo patients had a higher rate of postoperative transfusions (58% on-pump versus 27% off-pump, p = 0.001), prolonged ventilatory support (17% on-pump versus 4% off-pump, p = 0.03), and a higher rate of postoperative atrial fibrillation (29% on-pump versus 14% off-pump, p = 0.04). On-pump redo CABG was also associated with prolonged postoperative length of stay (8 +/- 4 days on-pump versus 5 +/- 2 days off-pump, p < 0.001). In-hospital mortality was significantly higher in on-pump than in off-pump patients (10% versus 1%, p = 0.03).
Conclusions:
Single-vessel off-pump redo CABG can be performed safely with a lower operative morbidity and mortality than on-pump CABG and an abbreviated hospital stay compared with conventional on-pump redo CABG.