Comparison of off-pump and conventional coronary endarterectomy

This study was designed to compare the early and midterm results of off-pump coronary endarterectomy (OPCE) with those of conventional coronary endarterectomy (CCE) performed with cardiopulmonary bypass.

From April 1, 1999, until March 1, 2001, 332 patients underwent off-pump coronary artery bypass grafting at our institution. From this total, 44 (13%) of the patients underwent supplementary OPCE (group 1). The results were compared with those for a group of age-, sex-, and risk factor-matched patients undergoing CCE (group 2) at the same institution. The mean follow-up period was 16 months. The indications for operation in group 1 were angina in 16 (36%) of the cases, cardiac failure in 20 (45%), and prognosis in 8 (19%). In group 2 angina was the indication for operation in 11 (25%) of the cases, cardiac failure in 5 (11%), and prognosis in 30 (64%) of the cases.

In group 1, 35 patients underwent single and 9 underwent double endarterectomy. The procedures included 32 right coronary artery, 12 left anterior descending artery, 2 lateral circumflex artery, and 7 diagonal branch operations. Three (6.8%) of the patients in group 1 and 2 (4.4%) of the patients in group 2 developed postoperative myocardial infarction (P <.05). One (2.2%) of the patients in group 1 and 2 (4.4%) of the patients in group 2 died in the postoperative period (P <.05). The numbers of patients with perioperative neurologic deficit in groups 1 and 2 were 0 and 7, respectively (P <.001). Although the rate of perioperative myocardial infarction was higher in group 1, mortality, occurrence of other morbid events, intubation time, intensive care stay, and hospital length of stay were less in group 1 than group 2.

OPCE can be performed safely with morbidity and mortality comparable with those of CCE.