Myocardial revascularization with and without cardiopulmonary bypass in multivessel disease patients

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Minimally Invasive Cardiac Procedures

Background:

• Off-pump coronary artery bypass (OPCAB) surgery is frequently performed due to its safety profile.
• The clinical effectiveness of OPCAB versus conventional on-pump coronary artery bypass (CABG) surgery remains a subject of debate, particularly in patients with multivessel disease.

Purpose of the Study:

• To retrospectively compare the early and late clinical outcomes of patients with multivessel disease who underwent either off-pump or on-pump coronary artery bypass surgery.
• To evaluate the impact of intraoperative conversion from off-pump to on-pump procedures on patient outcomes.

Main Methods:

• A retrospective analysis of 2957 patients with multivessel disease undergoing isolated coronary revascularization between November 1994 and December 2001.
• Patients were divided into on-pump (n = 1924) and off-pump (n = 1033) groups, with 65 conversions from off-pump to on-pump included in the off-pump cohort.

Main Results:

• Cardiopulmonary bypass use was an independent predictor of increased early mortality, negative primary endpoints, and major adverse events.
• Conversion to on-pump surgery was associated with higher early mortality and morbidity but did not impact long-term clinical outcomes.
• At 6-year follow-up, freedom from death, myocardial infarction, and repeat revascularization was comparable between the off-pump and on-pump groups.

Conclusions:

• Off-pump coronary artery bypass surgery is associated with reduced early mortality and morbidity.
• The long-term clinical outcomes for off-pump and on-pump surgery appear to be similar.
• While conversion to on-pump surgery increases early risks, it does not adversely affect the long-term prognosis.