Off-pump coronary artery bypass grafting: a case-matched comparison of hemodynamic outcome

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Minimally Invasive Cardiac Surgery

Background:

• Coronary artery bypass grafting (CABG) is a standard treatment for severe coronary artery disease.
• On-pump CABG using cardiopulmonary bypass and cardioplegia has been the traditional approach.
• Off-pump CABG (OPCAB) aims to improve myocardial protection by avoiding cardiopulmonary bypass.

Purpose of the Study:

• To evaluate the efficacy of off-pump CABG in enhancing myocardial protection compared to on-pump CABG.
• To compare hemodynamic outcomes and markers of myocardial injury between on-pump and off-pump CABG procedures.
• To assess the requirement for inotropic support in patients undergoing OPCAB versus traditional CABG.

Main Methods:

• A case-matched study comparing 45 pairs of patients undergoing on-pump CABG (Group 1) and off-pump CABG (Group 2).
• Patients were matched based on age, gender, body surface area, ejection fraction, and extent of coronary disease.
• Off-pump grafting utilized Octopus stabilizers, while on-pump utilized cold blood cardioplegia and cardiopulmonary bypass.

Main Results:

• No significant differences in cardiac index, ventricular stroke work indexes, or vascular resistance indexes between groups.
• Group 2 (off-pump) demonstrated a slower heart rate trend (P=0.05).
• Significantly reduced need for inotropic support (33% vs 65%, P<0.001) and lower CK-MB mass release in Group 2.

Conclusions:

• Off-pump CABG provides comparable hemodynamic results to on-pump CABG.
• Beating heart surgery reduces the reliance on pharmacological inotropic support post-operatively.
• Off-pump CABG is associated with markedly lower myocardial enzyme release, indicating improved myocardial protection.