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Coronary artery bypass grafting with and without cardiopulmonary bypass: a comparison analysis
K C Kirk1, R A Aldridge, J J Sistino
1Medical University of South Carolina, Charleston 29414, USA.
Insights
Off-pump coronary artery bypass grafting (OPCAB) shows potential benefits like shorter operating room time and reduced blood usage compared to conventional bypass. However, patient selection remains crucial for optimizing outcomes in this surgical approach.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
- Off-pump coronary artery bypass grafting (OPCAB) utilizes stabilization devices, avoiding the heart-lung machine.
- Evaluating OPCAB's performance against conventional CABG is essential for surgical decision-making.
Purpose of the Study:
- To retrospectively compare the outcomes of OPCAB versus conventional CABG.
- To analyze key performance indicators including complications, blood usage, and length of stay.
- To identify potential benefits and patient selection criteria for OPCAB.
Main Methods:
- Retrospective comparison of OPCAB and conventional CABG patients over a 6-month period.
- Data collected from the National Cardiac Database of the Society of Thoracic Surgeons (STS).
- Analysis of parameters including demographics, disease severity, operative details, and postoperative outcomes.
Main Results:
- No significant differences in age, gender, ejection fraction, previous myocardial infarction, predicted mortality, or hospital length of stay between groups.
- Similar operative mortality rates: 3% for conventional CABG vs. 2% for OPCAB.
- OPCAB group demonstrated significantly shorter operating room time (365 vs. 406 min), reduced ventilation hours (3.4 vs. 8.3 hrs), and less blood usage (1.1 vs. 2.4 units).
- Conventional bypass patients had more diseased vessels and distal grafts.
- 9.5% of OPCAB cases were converted to conventional bypass.
Conclusions:
- OPCAB offers potential advantages in reduced operating time, ventilation, and blood transfusion requirements.
- Operative mortality and long-term outcomes like length of stay were comparable between OPCAB and conventional CABG.
- Further research is needed to identify specific patient populations who would most benefit from the off-pump technique.
Abstract:
Coronary artery bypass grafting (CABG) using stabilization devices in place of the heart-lung machine is being performed on a wide range of patients. This study retrospectively compared the performance of off-pump coronary artery grafting bypass (OPCAB) with conventional bypass patients over the same 6-month period at The Medical University of South Carolina. Data were collected and compared from the National Cardiac Database of the Society of Thoracic Surgeons (STS). Parameters studied included age, gender, left ventricular ejection fraction (LVEF), previous myocardial infarction (MI), disease severity, number of grafts, complications, blood usage, ventilation times, operating room (OR) time, and hospital length of stay (LOS). There were no significant difference between the patient groups with regard to age, gender, LVEF, previous MI, predicted mortality, and LOS. Operative mortality was also similar in the two groups: conventional bypass 4/117 (3%) and OPCAB 2/86 (2%). The conventional bypass patients (CPB) had significantly (p < 0.05) more diseased vessels (2.9 vs. 2.6) and distal grafts (4.1 vs. 2.7), as compared to the OPCAB group. OPCAB procedures resulted in significantly (p < 0.05) lower mean OR time (365 min vs. 406 min) and reduced mean postoperative ventilation hours (3.4 vs. 8.3 hours), as compared to conventional bypass. There were significantly (p < 0.05) fewer blood transfusions in the OPCAB group (1.1 units vs. 2.4 units), and the percentage of patients transfused blood was significantly less (34.9% vs. 57.3%). Nine out of 95 (9.5%) of patients who presented for OPCAB were converted to conventional bypass. Although there may be potential benefits to OPCAB, further studies must be directed at determining those patients who would benefit most from CABG using the off-pump technique.