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Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB): a strategy for improving results in
J Bergsland1, S Schmid, J Yanulevich
1The Center for Less Invasive Cardiac Surgery, State University of New York at Buffalo and Buffalo General Hospital, 100 High Street, Buffalo, New York, NY 14203, USA. nielsb@aol.com
Insights
Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is effective. Avoiding CPB in CABG surgery leads to fewer complications, especially for older patients with comorbidities.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Devices
Background:
- Coronary artery bypass grafting (CABG) is a surgical procedure to improve blood flow to the heart.
- This study compares CABG performed with cardiopulmonary bypass (CPB) versus without CPB (non-CPB).
- The study included patients who underwent CABG between January 1995 and September 1997.
Purpose of the Study:
- To compare the outcomes of CABG performed with and without CPB.
- To evaluate the impact of CPB on postoperative morbidity and mortality.
- To determine if avoiding CPB is beneficial for specific patient groups.
Main Methods:
- A retrospective analysis of 3374 CABG patients (2869 CPB group, 505 non-CPB group).
- Data collected and analyzed by the New York State Department of Health.
- Comparison of preoperative comorbidity, postoperative morbidity, and mortality between the two groups.
Main Results:
- Patients undergoing non-CPB CABG had higher rates of reoperations (31.9% vs. 8.5%), extensively calcified aorta (5.9% vs. 2.8%), and immune deficiency.
- Risk-adjusted mortality was similar between groups.
- Major complications were significantly less common in the non-CPB group (90.1% complication-free vs. 84.3% in CPB group).
Conclusions:
- Coronary artery bypass grafting without CPB is an effective and attractive surgical revascularization strategy.
- Avoiding CPB appears most beneficial for patients with increasing age and preoperative comorbidity.
- These findings suggest a shift in surgical strategy towards minimizing CPB use in CABG.
Background:
Coronary artery bypass grafting (CABG) was performed on patients with cardiopulmonary bypass (CPB group) or without CPB (non-CPB group). A series of CABG patients, performed between January 1, 1995 and September 30, 1997 is included.
Methods:
Data were collected and analyzed as determined by the New York State Department of Health. Preoperative comorbidity, postoperative morbidity and mortality were compared. There were 2869 patients in the CPB group and 505 patients in the non-CPB group.
Results:
Demographics of the two groups were similar but preoperative risk factors were more common in patients undergoing CABG without CPB. Of the non-CPB patients, 31.9% had reoperations as compared to 8.5% in CPB patients (p = 0.00005). The presence of an extensively calcified aorta was more common in the non-CPB patients (5.9% vs. 2.8%, p = 0.0002). Immune deficiency was also more common in the non-CPB group (p = 0.001). Risk-adjusted mortality was similar in the two groups while major complications were much less common when CPB was not utilized. In CPB patients only 84.3% avoided major complications, while among non-CPB patients 90.1% were complication-free (p = 0.0008).
Conclusions:
CABG without CPB is an attractive method of surgical revascularization. Increasing age and preoperative comorbidity in patients referred for CABG dictate changes in surgical strategy, of which avoidance of CPB appears most beneficial.
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