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Cost performance and efficacy of off-pump coronary artery bypass grafting
Fumikazu Nomura1, Shogo Mukai, Kentaro Tamura
1Cardiovascular Surgery, National Hospital, Kure Medical Center, Hiroshima, Japan. fnomura@kure-nh.go.jp
Insights
Off-pump coronary artery bypass grafting (Off-Pump CABG) is a less invasive, more cost-effective surgical option. This study shows Off-Pump CABG has similar efficacy to On-Pump CABG with reduced complications and lower overall costs.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- Cardiopulmonary bypass (CPB) used in traditional On-Pump CABG can lead to complications, especially in high-risk patients.
- Off-pump coronary artery bypass grafting (Off-Pump CABG) offers an alternative surgical approach without CPB.
Purpose of the Study:
- To compare the efficacy and cost-effectiveness of Off-Pump CABG versus On-Pump CABG.
- To evaluate postoperative outcomes and biochemical markers in patients undergoing Off-Pump CABG.
- To assess the suitability of Off-Pump CABG for high-risk patient populations.
Main Methods:
- A comparative study of 28 Off-Pump CABG patients and 36 On-Pump CABG control patients.
- Inclusion of high-risk patients with preoperative complications in the Off-Pump CABG group.
- Analysis of postoperative biochemical markers (CK, CKMB, LDH, GOT), graft patency, and total costs.
Main Results:
- Significantly lower peak release of myocardial injury markers (CK, CKMB, LDH, GOT) in the Off-Pump CABG group.
- Similar graft patency rates between Off-Pump CABG (98%) and On-Pump CABG (98%).
- Significantly lower total costs for surgery and patient care in the Off-Pump CABG group ( $21,000 ± $7,000) compared to On-Pump CABG ($33,000 ± $4,200).
Conclusions:
- Off-Pump CABG is a less invasive surgical technique with reduced myocardial stress.
- Off-Pump CABG demonstrates comparable efficacy to On-Pump CABG.
- Off-Pump CABG is a more cost-effective revascularization strategy, particularly beneficial for high-risk patients.
Abstract:
Off-pump coronary artery bypass grafting (Off-Pump CABG) may provide an alternative form of surgical revascularization by avoiding the unwanted complications of cardiopulmonary bypass, particularly in high-risk patients. To clarify the efficacy and cost performance of Off-Pump CABG, we studied the postoperative course of Off-Pump CABG and compared it to On-pump coronary artery bypass grafting (On-Pump CABG). From Aug. 1998 to Feb. 2002, twenty-eight patients who had preoperative complications such as cerebral vascular disease (11), chronic renal failure (4), atheromatous aorta (4), one lung (1), severely impaired left ventricular function (6), re-do CABG (1), and cancer (1) underwent Off-Pump CABG. Another thirty-six patients who underwent On-Pump CABG served as a control. The Off-Pump CABG patients were almost the same age as the On-Pump CABG patients (68 +/- 8 vs 64 +/- 8 years, ns). The Number of grafts was similar in both groups (2.6 +/- 1.0 vs 2.9 +/- 1.0, ns). Peak CK, peak CKMB, peak LDH, and peak GOT release were significantly lower in the Off-Pump CABG group compared with the On-Pump CABG group. Graft patency rates were similar in both groups (98% in Off-Pump CABG vs 98% in On-Pump CABG). The total cost for surgery and patient care was significantly lower (p < 0.0001) in the Off-Pump CABG group (dollar 21000 +/- 7000) compared with the On-Pump CABG group (dollar 33000 +/- 4200). Off-Pump CABG is less invasive to the myocardium, is less expensive, and has a similar efficacy in comparison with On-Pump CABG.