A comparison of consecutive off-pump versus conventional coronary artery bypass

Coronary revascularization on the beating heart is an attractive alternative to conventional coronary artery bypass grafts (CCABG), but remains controversial. Our study compares the outcomes of consecutive patients undergoing off-pump CABG (OPCABG) with a group of similar patients undergoing consecutive CCABG.

A retrospective analysis of 268 patients who underwent elective CABG between July 1998 and July 1999 at St. Michael's Medical Center yielded 134 consecutive patients who underwent OPCABG and 134 consecutive patients who had CCABG. Patients' medical charts were reviewed for age, preoperative risk factors, operative findings, postoperative complications, and length of stay (LOS).

The two cohorts were well matched, with similar ages (66.4 +/- 11.2 for OPCABG vs. 65.8 +/- 10 for CCABG, p = 0.66) and preoperative ejection fractions (EF) (44 +/- 13 vs. 44 +/- 12, p = 0.85). There were no hospital mortalities, and there were five conversions to cardiopulmonary bypass. The OPCABG group had a significantly shorter ICU and postoperative LOS.

Our data suggests that a fair number of patients are potential candidates for OPCABG, the only contraindications being technical limitations or the surgeon's comfort level. Six- to twelve-month follow-up indicates that OPCABG can be performed safely with a decrease in LOS, and should be part of the surgeon's armamentarium.