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Does off-pump coronary artery bypass surgery reduce mortality in high risk patients?
B Akpinar1, M Guden, I Sanisoglu
1Department of Cardiac Surgery, Kadir Has University Medical Faculty, Florence Nightingale Hospital Istanbul-Turkey. belh@turk.net
Insights
Off-pump coronary artery bypass grafting (CABG) offers comparable outcomes to on-pump CABG for low-risk patients. For high-risk patients, off-pump CABG demonstrates improved outcomes and safety.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Thoracic Surgery
Background:
- Coronary revascularization is a critical procedure for managing coronary artery disease.
- The choice between on-pump (using cardiopulmonary bypass) and off-pump techniques impacts patient outcomes.
- Risk stratification is essential for tailoring surgical approaches in coronary artery bypass grafting (CABG).
Purpose of the Study:
- To compare the outcomes of coronary revascularization with and without cardiopulmonary bypass (CPB).
- To evaluate the safety and efficacy of off-pump CABG versus conventional CABG across different patient risk groups.
- To analyze postoperative complications and resource utilization in both surgical approaches.
Main Methods:
- A retrospective study included 480 patients undergoing CABG between January 1996 and July 2000.
- Patients were divided into two groups: Group 1 (off-pump CABG, n=210) and Group 2 (on-pump CABG, n=270).
- Patients were risk-stratified using the Allegheny Clinic Risk Scoring Scale; high-risk patients comprised 37% of Group 1 and 14% of Group 2.
Main Results:
- Overall mortality rates were similar between groups (1.4% vs. 1.5%).
- Off-pump CABG (Group 1) required fewer anastomoses per patient, less blood transfusion, and reduced inotropic support.
- Group 1 experienced fewer minor neurological events and pulmonary complications; atrial fibrillation, infection, and major neurological deficits were similar.
Conclusions:
- Coronary artery bypass grafting (CABG) can be safely performed with or without cardiopulmonary bypass (CPB) in low or moderate-risk patients.
- Off-pump CABG appears to be a safe and effective method for high-risk patients with comorbidities, potentially improving outcomes.
- The study suggests a benefit of off-pump techniques in reducing certain postoperative complications, particularly in higher-risk populations.
Background:
The aim of this retrospective study was to compare outcome in two groups of patients who were classified according to their risk groups and underwent coronary revascularization with or without cardiopulmonary bypass.
Material And Methods:
Between January 1996 and July 2000, 480 cases that underwent coronary artery bypass surgery (CABG) were included in a retrospective nonrandomized manner for study. Group 1 included 210 patients who were revascularized using off-pump techniques. Octopus 2 and 3 (Medtronic, Inc., Minneapolis, MN) were used for tissue stabilization. Group 2 included 270 cases who underwent CABG using CPB. Emergency cases, combined operations, reoperations, and patients in cardiogenic shock were excluded. Demographic variables were comparable between two the groups. Using the Allegheny Clinic Risk Scoring Scale [Magovern 1996], patients in both groups were scored as low, moderate, and high risk. In Group 1, 37 % of patients consisted of high risk patients while Group 2 had 14% (p < 0.05). Student's t-test and chi-square test were used for statistical analysis and alfa < 0.05 was considered significant.
Results:
Mortality was 1.4% in Group 1 and 1.5% in Group 2 (p = ns). Mean anastomosis per patient was 2.6 +/- 0.6 in Group 1 and 3.2 +/- 0.5 in Group 2 (p < 0.05). Patients in Group 1 needed less blood transfusions and less inotropic support postoperatively (p < 0.05). There were also fewer minor neurological events (p < 0.05) and pulmonary complications (Type 2) in Group 1. Atrial fibrillation rate, infection, and major neurological deficit (Type 1) were similar in both groups. Mortality was less among Group 1 high risk patients (3.9 %) in comparison to Group 2 high risk patients (7.9 %), but this did not reach statistical significance.
Conclusions:
In low or moderate risk patients, CABG can be performed safely with or without CPB. In high risk patients with several comorbidities, off-pump CABG seems to be a safe and efficient method that can improve outcome.