Off-pump versus on-pump CABG in high-risk patients: short- and mid-term outcome

During recent years Conventional Coronary Artery Bypass Grafting (cCABG) and Off-Pump Coronary Bypass (OPCAB) have been compared in several randomised and non-randomised studies. Focus has been on postoperative outcome with short-term follow-up in low-risk patients and therefore little is known of the effectiveness of OPCAB in high-risk patients. Furthermore, it is unknown if a potential beneficial short-term outcome is consistent over time.

In 2001, 217 patients with a Euroscore > or =5 were included in an observational cohort study; 162 patients were operated by cCABG and 55 by OPCAB. Follow-up data were retrieved from the Danish national person registry. The study includes a mid-term follow-up, with a mean follow-up time of 3.97 years+/-0.32.

No differences in mortality between OPCAB and cCABG were found. In-hospital mortality was 5.5% in the OPCAB group vs 5.6% in the cCABG group and mid-term mortality was 21.8% in the OPCAB group vs 24.7% in the cCABG group; p = 0.71. During the follow-up period 41.5% of patients with an EF < or =35% at the time of surgery and 43.3% of patients with a Euroscore >8 died. Seven percent in the cCABG group had a perioperative AMI vs none in the OPCAB group; p < 0.05. In 74.5% cCABG's allogenic transfusions of blood components was necessary vs only 55.6% OPCAB's (p < 0.05). No significant differences in CNS complications or atrial fibrillation could be demonstrated.

A similar outcome between OPCAB in cCABG in high-risk patients with respect to mortality was found. OPCAB seems to have a beneficial effect on morbidity. A cautious approach to patients with a combined high Euroscore and low ejection fraction should be the strategy of choice.