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Off-pump versus on-pump CABG: a comparison
A R Raghuram1, M R Sayeed, M R Girinath
1Department of Cardio Thoracic Surgery, Apollo Hospitals, Chennai. arraghuram@yahoo.com
Insights
Off-pump coronary artery bypass grafting (CABG) is as safe as on-pump CABG. While organ dysfunction and blood product use were similar, off-pump surgery showed fewer instances of low cardiac output and inotrope use.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a common procedure.
- The off-pump technique aims to reduce complications associated with cardiopulmonary bypass.
Purpose of the Study:
- To compare the safety and efficacy of off-pump versus on-pump CABG.
- To evaluate complications such as mortality, infarction, organ dysfunction, and blood product usage.
Main Methods:
- Prospective analysis of 53 patients undergoing on-pump CABG and 48 patients undergoing off-pump CABG.
- Data collected included demographic, operative, and postoperative variables.
- Statistical analysis was performed to compare outcomes between the two groups.
Main Results:
- No significant differences in mortality, perioperative infarction, or overall organ dysfunction between on-pump and off-pump CABG.
- Similar incidence of renal and pulmonary dysfunction, with no neurological complications in either group.
- Lower incidence of low cardiac output and inotrope use observed in the off-pump group.
Conclusions:
- Off-pump CABG is a safe alternative to on-pump CABG.
- The study did not support claims of reduced organ dysfunction or blood product use with off-pump surgery.
- Off-pump CABG demonstrated a significant reduction in low cardiac output and inotrope requirements.
Background:
The off-pump technique reduces the complications of coronary artery bypass grafting performed with extracorporeal circulatory assistance. This hypothesis was tested by analyzing the results of 53 patients operated with and 48 without cardiopulmonary bypass by a single surgeon (ARR) from February 2001 to September 2001.
Methods And Results:
The angiograms of all the patients scheduled for isolated coronary artery bypass grafting were carefully analyzed and a plan for revascularization made. After sternotomy and inspection of the vessels, a decision was taken to perform the surgery on- or off-pump. All the demographic, operative and postoperative data were prospectively collected and analyzed statistically. Major end-points, such as mortality, perioperative infarction and organ dysfunction, were not different between the two techniques. The incidence of renal and pulmonary dysfunction was similar. There were no neurological problems in either group. In contrast to many reports. bleeding complications and the use of blood products were the same in both groups (1.6+/-2.3 in the on-pump group and 0.8+/-1.7 in off-pump group: p=0.06). The only important difference between the two groups was the incidence of low cardiac output and use of inotropes, being more common in the on-pump group.
Conclusions:
Off-pump coronary artery bypass grafting is as safe as that done on-pump. The claims of a lower incidence of organ dysfunction and blood product use in the off-pump group were not substantiated in this study. The incidence of low cardiac output and use of inotropes was significantly lower in the off-pump group.