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

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery

Background:

• Coronary artery bypass graft (CABG) surgery offers two main approaches: on the beating heart (off-pump) or with heart-lung machine assistance (on-pump).
• While off-pump CABG is appealing, its use remains debated, necessitating careful consideration of procedural changes.

Purpose of the Study:

• To evaluate the safety and outcomes of patients who required a change in strategy from off-pump to on-pump coronary artery bypass graft surgery during the procedure.
• To determine if intraoperative decisions to switch CABG techniques impact postoperative complications.

Main Methods:

• Retrospective analysis of 240 patients undergoing coronary artery bypass graft surgery between July 1998 and July 2000.
• Identified 88 patients who underwent off-pump CABG (off CAB), including 21 who were converted to on-pump CABG during surgery. The remaining 131 patients underwent standard on-pump CABG.

Main Results:

• No operative mortality was observed in the study cohort.
• One-month postoperative mortality was low (1/21), attributed to cardiac failure and arrhythmias in one patient who switched from off-pump to on-pump CABG.
• No significant differences were found in postoperative intensive care unit (ICU) stay or overall hospital length of stay between patients who underwent off-pump CABG and those converted to on-pump CABG.

Conclusions:

• A significant number of patients are suitable candidates for off-pump coronary artery bypass graft surgery.
• Technical limitations or surgeon comfort are the primary contraindications for off-pump CABG.
• Converting from off-pump to on-pump CABG intraoperatively is a safe strategy, allowing for patient safety without increasing postoperative complications compared to solely off-pump procedures.