Off-pump coronary bypass for patients with concomitant malignancy

The effectiveness and advantages of off-pump coronary artery bypass (OPCAB) for patients with concomitant malignant neoplastic disorders were analyzed.

The study group comprised 368 patients who underwent OPCAB and of them 18 had concomitant malignant neoplastic disease: 14 with solitary malignant disease, 4 with low-grade lymphocytic malignancies. The age of the patients ranged from 49 to 72 years (mean 61). The mean left ventricular ejection fraction was 46.4% (range: 35-60%) and the mean number of grafts was 2.4+/-0.9. The left internal mammary artery was used in 12 patients (75%). Mean blood loss was 420+/-64 ml and the average requirement for blood transfusion was 1.1+/-0.2 units. There was no postoperative infection or in-hospital mortality. The mean length of hospital stay was 6.4+/-1.3 days. Mid-term follow-up was completed (100%) and the mean follow-up period was 22.6+/-4.1 months. All patients with a solitary malignancy underwent subsequent non-cardiac surgery with a mean interval of 16.4+/-3.3 days. Mid-term survival was 83.4%. Freedom from late cardiac events (angina, myocardial infarction, percutaneous transluminal coronary angioplasty) that required hospital admission was 92.3%.

These results support the effectiveness of OPCAB, mostly as a bridge to safe non-cardiac surgery that can be crucial for long-term survival.