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Does off-pump coronary surgery reduce morbidity and mortality?
Joseph F Sabik1, A Marc Gillinov, Eugene H Blackstone
1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. sabikj@ccf.org
Insights
Off-pump coronary artery bypass grafting (CABG) showed lower postoperative morbidity compared to on-pump CABG. However, on-pump CABG resulted in more complete revascularization, with similar early mortality rates for both procedures.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure for coronary artery disease.
- On-pump CABG utilizes cardiopulmonary bypass, while off-pump CABG is performed without it.
- Comparing outcomes between these two techniques is crucial for optimizing patient care.
Purpose of the Study:
- To compare the hospital outcomes of on-pump versus off-pump coronary artery bypass surgery.
- To identify differences in postoperative morbidity and mortality between the two surgical approaches.
Main Methods:
- A retrospective analysis of 481 off-pump and 3231 on-pump CABG patients from 1997-2000.
- Propensity-matched analysis of 406 pairs of on-pump and off-pump patients.
- Comparison of baseline characteristics including age, left ventricular function, and comorbidities.
Main Results:
- On-pump CABG involved more grafts (3.5 vs. 2.8) to more coronary territories.
- Postoperative mortality, stroke, and myocardial infarction were similar between groups.
- On-pump CABG patients experienced higher rates of encephalopathy, sternal wound infection, red blood cell transfusion, and renal failure requiring dialysis.
Conclusions:
- Both on-pump and off-pump CABG yield excellent early clinical results with low mortality.
- Off-pump CABG is associated with reduced postoperative morbidity.
- Concerns regarding less complete revascularization in off-pump procedures warrant further investigation into long-term outcomes.
Objective:
To compare hospital outcomes of on-pump and off-pump coronary artery bypass surgery.
Methods:
From 1997 to 2000, primary coronary artery bypass grafting was performed in 481 patients off pump and in 3231 patients on pump. Hospital outcomes were compared between propensity-matched pairs of 406 on-pump and 406 off-pump patients. The 2 groups were similar in age (P =.9), left ventricular function (P =.7), extent of coronary artery disease (P =.5), carotid artery disease (P =.4), and chronic obstructive pulmonary disease (P =.5). However, off-pump patients had more previous strokes (P =.05) and peripheral vascular disease (P =.02); on-pump patients had a higher preoperative New York Heart Association class (P =.01).
Results:
In the matched pairs the mean number of bypass grafts was 2.8 +/- 1.0 in off-pump patients and 3.5 +/- 1.1 in on-pump patients (P <.001). Fewer grafts were performed to the circumflex (P <.001) and right coronary (P =.006) artery systems in the off-pump patients. Postoperative mortality, stroke, myocardial infarction, and reoperation for bleeding were similar in the 2 groups. There was more encephalopathy (P =.02), sternal wound infection (P =.04), red blood cell use (P =.002), and renal failure requiring dialysis (P =.03) in the on-pump patients.
Conclusions:
Both off- and on-pump procedures produced excellent early clinical results with low mortality. An advantage of an off-pump operation was less postoperative morbidity; however, less complete revascularization introduced uncertainty about late results. A disadvantage of on-pump bypass was higher morbidity that seemed attributable to cardiopulmonary bypass.