Total arterial off-pump coronary surgery: time to change our habits?

This was a single-institutional study about total arterial myocardial off-pump coronary artery bypass grafting (OPCAB) surgery.

We studied 569 multivessel coronary artery bypass patients who underwent total arterial OPCAB (42.7% of total OPCAB and 42.4% of total coronary artery bypass grafting operations) between June 2000 and June 2003. Risk profile was moderate to high, with a mean logistic EuroSCORE of 6.2 +/- 5.1. Univariate and multivariate analysis were used to find determinants of in-hospital death, neurologic events, and cardiac-related events at follow-up. Overall survival was determined by the Kaplan-Meier method. Linearized complication rates at follow-up are reported.

In-hospital mortality was 2.3%. At univariate analysis, significant determinants of in-hospital mortality were age, logistic EuroSCORE greater than 15, diabetes, extracardiac arteriopathy, New York Heart Association class IV, ejection fraction less than 30%, and intraaortic balloon pump. At multivariate analysis, extracardiac arteriopathy and New York Heart Association class IV were the independent predictors for in-hospital mortality. Neurologic events were 1.1%. At univariate analysis, significant determinants of neurologic events were age, logistic EuroSCORE greater than 15, and extracardiac arteriopathy. At multivariate analysis no independent factor for neurologic events was found. Survival at 36 months was 95.6% +/- 0.9%, and freedom from cardiac-related events at follow-up was 91.6% +/- 1.7%. Linearized rates of cardiac-related events during follow-up were as follows: recurrence of angina, 1.1% +/- 0.3%/y; myocardial infarction, 0.6% +/- 0.2%/y; congestive heart failure, 1.2% +/- 0.3%/y; graft occlusion, 0.4% +/- 0.2%/y; and re-coronary artery bypass grafting, 0.2% +/- 0.1%/y.

Total arterial OPCAB has a safe outcome in terms of mortality and neurologic events and has a low linearized rate of cardiac-related events at follow-up, even for patients with a moderate- to high-risk profile.