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Published on: November 24, 2014
Off-pump bypass grafting is safe in patients with left main coronary disease
T M Dewey1, M J Magee, J R Edgerton
1Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA. tdewey@csant.com
Insights
Off-pump coronary artery bypass grafting is safe and effective for patients with left main coronary artery disease. This technique avoids cardiopulmonary bypass, reducing mortality and the need for inotropic support and transfusions.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Off-pump coronary artery bypass grafting (CABG) has been limited for left main coronary artery stenosis due to concerns about tolerating beating heart procedures.
- Historically, patients with left main coronary artery disease were excluded from off-pump CABG.
Purpose of the Study:
- To evaluate the safety and efficacy of off-pump coronary artery bypass grafting in patients with left main coronary artery disease.
- To compare outcomes of off-pump CABG versus on-pump CABG in this patient population.
Main Methods:
- A retrospective review of 823 patients with left main coronary artery disease undergoing CABG between January 1998 and October 1999.
- Comparison of 100 patients who underwent off-pump CABG with 723 patients who underwent on-pump CABG, all with multivessel grafting via sternotomy.
Main Results:
- Off-pump CABG had a lower mortality rate (1% vs. 4.7%) compared to on-pump CABG, though not statistically significant (p=0.059).
- Patients undergoing off-pump CABG required significantly less postoperative inotropic support (23% vs. 62%, p < 0.001) and transfusion (35% vs. 67%, p < 0.001).
- Cardiopulmonary bypass was identified as an independent risk factor for mortality (OR, 7.3; 95% CI, 1.34-138.4).
Conclusions:
- Coronary artery bypass grafting using off-pump techniques is safe and effective for patients with left main coronary artery disease.
- Off-pump CABG offers significant benefits in reducing the need for postoperative inotropic support and transfusions.
Background:
Because of a concern about the ability to tolerate beating heart grafting, patients with left main coronary artery stenosis have been excluded from off-pump bypass. We reviewed our experience with off-pump coronary artery bypass grafting for patients with left main coronary artery disease.
Methods:
Eight hundred twenty-three patients underwent bypass grafting for left main coronary artery disease from January 1998 to October 1999. One hundred patients were revascularized without the use of cardiopulmonary bypass and compared with a contemporaneous cohort of 723 patients who underwent grafting with the aid of cardiopulmonary bypass. All patients had multivessel grafting performed through a sternotomy.
Results:
There was one death (1%) in the group undergoing off-pump grafting as compared with a 30-day mortality of 4.7% (p = 0.059) in the on-pump group. Univariate analysis established that patients revascularized without cardiopulmonary bypass were significantly less likely to require postoperative inotropic support (23% versus 62%, p < 0.001) and transfusion (35% versus 67%, p < 0.001). Logistic regression analysis revealed that cardiopulmonary bypass was an independent risk factor for mortality (odds ratio, 7.3; 95% confidence interval, 1.34 to 138.4).
Conclusions:
Coronary artery bypass grafting using off-pump techniques are safe and effective in left main coronary artery disease.
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