Off-pump on-pump coronary artery bypass decision-making

Coronary revascularization on the beating heart is an attractive to option conventional coronary artery bypass graft (CABG) but remains controversial. Our study encourages sufficient proper time for decision-making when changing CABG from off-pump to on-pump CABG. We report herein patients who changed from off-pump CABG to on-pump CABG.

A retrospective analysis of 240 patients operated upon at Cardiology Hospital of Lyon University between July 1998 and July 2000, and at one unit of Cardiac Surgery, yielded 88 patients with off-pump coronary surgery (off CAB), 21 patients changed from off-pump CABG to on-pump CABG. The other 131 patients were operated on as on-pump CABG.

There was no operative mortality. One month postoperative mortality was only one patient out of 21 due to cardiac failure and arrhythmias. There was no significant difference in the postoperative intensive care unit (ICU) time and length of hospital stay compared with off-pump CABG.

Our data suggest that a fair number of patients are potential candidates for off CAB. The only contraindication is the technical limitation or the surgeon comfort level. Changing from off CAB to on CAB can be decided for the patient's safety within the appropriate time intraoperatively without fear of more postoperative complications than with off CAB surgery.