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Off-pump coronary artery bypass grafting for patients with three-vessel disease
Hitoshi Hirose1, Atushi Amano, Akihito Takahashi
1Department of Cardiovascular Surgery, Kobari General Hospital, Chiba, Japan.
Insights
Off-pump coronary artery bypass grafting (CABG) offers faster recovery for patients with three-vessel disease. This technique shows equivalent complication and early follow-up results compared to traditional on-pump CABG.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
Background:
- Off-pump coronary artery bypass grafting (CABG) has been utilized since 1996.
- Its application has expanded to patients with three-vessel disease.
Purpose of the Study:
- To clarify the benefits of off-pump CABG in patients with three-vessel disease.
- To compare outcomes of off-pump CABG versus on-pump CABG in this patient group.
Main Methods:
- Retrospective analysis of a historical cohort of 1089 on-pump CABG patients (1991-2001).
- Comparison with a concurrent cohort of 310 off-pump CABG patients (post-1997).
- Analysis of demographic data, comorbidities, and postoperative outcomes.
Main Results:
- Off-pump CABG group had a shorter mean intubation period, ICU stay, and hospital stay (P <.0001).
- No significant differences in in-hospital mortality or morbidity rates between groups.
- Equivalent 2-year event-free rates (93.3% off-pump vs. 91.9% on-pump).
Conclusions:
- Off-pump CABG facilitates early recovery in patients with multivessel disease.
- Complication rates and early follow-up results are comparable to on-pump CABG.
Background:
Off-pump coronary artery bypass grafting (CABG) has been performed since 1996 in our institute, and its application has recently been expanded to patients with three-vessel disease. A study was performed to clarify the benefit of off-pump CABG for patients with three-vessel disease.
Methods:
Between June 1, 1991 and September 30, 2001, a total of 1089 patients with three-vessel disease (832 men and 257 women; mean age, 64.0 +/- 9.1 years) underwent on-pump CABG. After 1997, a total of 310 patients with three-vessel disease (223 men and 87 women; mean age, 68.8 +/- 8.6 years) underwent off-pump CABG. Data of the historical cohort of on-pump CABG and the concurrent cohort of off-pump CABG were analyzed retrospectively.
Results:
The 2 groups were age and gender matched. Significant comorbidities were more often observed in the off-pump group than in the on-pump group. The mean number of bypass grafts in the off-pump versus on-pump CABG was 3.3 vs 3.7, P <.0001. The mean intubation period, intensive care unit stay, and postoperative hospital stay were 7.9 vs 11.7 hours, 2.2 vs 3.0 days, and 14.5 vs 17.5 days, respectively (P <.0001). In-hospital mortality rate (0.6% vs 1.2%, respectively) and morbidity rates (10.3% vs 12.9%, respectively) were not significantly different. After surgery, calculated event-free rates at 2 years were 93.3% vs 91.9%, respectively; P = not significant.
Conclusions:
In patients with multivessel disease, off-pump CABG provided early recovery, and its complication rates and early follow-up results were equivalent to on-pump CABG.