Does multivessel, off-pump coronary artery bypass reduce postoperative morbidity?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery

Background:

• Off-pump coronary artery bypass (OPCAB) is an emerging surgical technique.
• Eliminating cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG) may reduce postoperative morbidity.
• This review compares the safety and impact of multivessel OPCABG versus traditional CABG.

Purpose of the Study:

• To evaluate the safety and impact of multivessel off-pump coronary artery bypass grafting (OPCABG).
• To compare multivessel OPCABG with conventional coronary artery bypass grafting (CABG) using cardiopulmonary bypass.

Main Methods:

• Retrospective review of 744 patients undergoing multivessel coronary artery bypass between January 1997 and March 1999.
• Patients were divided into two groups: Group A (n=609) with cardiopulmonary bypass and Group B (n=135) undergoing OPCAB.
• All patients underwent elective full sternotomy with at least three distal anastomoses.

Main Results:

• Mean risk-adjusted predicted mortality was similar between groups (2.3% in Group A vs. 2.7% in Group B, p=NS).
• Major postoperative complications were comparable between groups.
• Significant differences were observed in postoperative blood loss and blood transfusion requirements (p < 0.001).

Conclusions:

• Multivessel OPCABG is a safe procedure for carefully selected patients.
• Eliminating cardiopulmonary bypass did not significantly decrease postoperative morbidity in this study.
• Further prospective randomized trials are necessary to define optimal patient selection and the long-term role of OPCABG.