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Related Experiment Videos

Off-pump versus on-pump coronary bypass in high-risk subgroups.

T Yokoyama1, F J Baumgartner, A Gheissari

  • 1St. Vincent Medical Center, Los Angeles, California, USA.

The Annals of Thoracic Surgery
|November 28, 2000
PubMed
Summary
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Effect of off-pump coronary artery bypass grafting on morbidity.

The American journal of cardiology·2000

Off-pump coronary bypass (OPCAB) surgery reduced transfusions and showed trends toward lower morbidity and mortality compared to traditional cardiopulmonary bypass (CPB) in high-risk patients. While OPCAB did not eliminate neurologic events, it offered benefits for specific patient groups.

Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Cardiac Procedures
  • Patient Outcomes Research

Background:

  • Cardiopulmonary bypass (CPB) can cause severe complications, particularly in high-risk patient subsets.
  • Investigating alternative surgical techniques like off-pump coronary artery bypass (OPCAB) is crucial for optimizing outcomes in these vulnerable populations.

Purpose of the Study:

  • To determine if off-pump coronary artery bypass (OPCAB) surgery can optimize patient outcomes compared to traditional cardiopulmonary bypass (CPB).
  • To evaluate the efficacy of OPCAB in high-risk patient subgroups, including the elderly, those with ventricular dysfunction, prior adverse events, COPD, and those undergoing reoperation.

Main Methods:

  • A comparative analysis was conducted between 242 OPCAB patients and 483 patients who underwent conventional coronary artery bypass grafting (CABG) with CPB.

Related Experiment Videos

  • Outcomes were assessed for the overall patient cohort and specifically within high-risk subsets: age ≥ 80, ejection fraction (EF) ≤ 0.25, prior neurologic event or renal failure, COPD, and reoperation.

    • Main Results:

    • OPCAB significantly reduced intraoperative transfusion requirements compared to CPB.
    • A trend towards reduced morbidity was observed with OPCAB, including fewer postoperative neurologic and renal complications, less prolonged ventilation (>3 days), and reduced need for reoperation due to bleeding.
    • Mortality was lower in the OPCAB group (0.4% vs. 2.7%), though not statistically significant. Similar beneficial trends were noted across all high-risk subgroups, with significant reductions in prolonged ventilation for COPD patients and renal complications for the elderly.

    Conclusions:

    • Off-pump coronary artery bypass (OPCAB) surgery significantly decreases the need for blood transfusions compared to cardiopulmonary bypass (CPB).
    • OPCAB demonstrates a consistent trend in reducing overall morbidity and mortality, especially within high-risk patient populations.
    • While OPCAB reduces the incidence of neurologic events, it does not completely eliminate them, particularly in elderly patients.