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Published on: September 15, 2023
Off-pump versus on-pump coronary artery bypass surgery in high-risk patients (EuroSCORE >/= 6)
J Lahtinen1, F Biancari, J Rimpiläinen
1Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
Insights
Off-pump coronary artery bypass surgery (OPCAB) is as safe and effective as conventional on-pump coronary artery bypass surgery (CCAB) for high-risk patients. Both procedures demonstrated similar outcomes for major endpoints, including death and stroke rates.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- High-Risk Patient Management
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- On-pump CABG (CCAB) utilizes cardiopulmonary bypass, while off-pump CABG (OPCAB) avoids it.
- The safety and efficacy of OPCAB versus CCAB in high-risk populations remain a subject of investigation.
Purpose of the Study:
- To compare the outcomes of OPCAB and CCAB in high-risk patients.
- To evaluate thirty-day postoperative mortality and morbidity.
- To identify predictors of adverse outcomes in this patient cohort.
Main Methods:
- A cohort study comparing patients undergoing OPCAB (n=67) versus CCAB (n=112).
- Inclusion criteria included an additive EuroSCORE of 6 or greater.
- Propensity score matching was employed to adjust for baseline differences.
Main Results:
- Thirty-day postoperative death rates were 7.5% for OPCAB and 5.4% for CCAB (P=0.75).
- Stroke rates were 6.0% for OPCAB and 8.0% for CCAB (P=0.77).
- No significant differences were found in major endpoints, except for cardiac troponin I levels, potentially influenced by preoperative conditions in two OPCAB patients. Congestive heart failure and baseline cardiac index independently predicted 30-day mortality.
Conclusions:
- Off-pump coronary artery bypass surgery (OPCAB) can be safely performed in high-risk patients.
- OPCAB offers satisfactory results comparable to conventional on-pump coronary artery bypass surgery (CCAB).
- Congestive heart failure and low cardiac index are critical predictors of adverse outcomes in this high-risk group.
Objective:
The aim of this study was to review the results of off-pump (OPCAB) versus conventional on-pump coronary artery bypass surgery (CCAB) in high-risk patients.
Methods:
In a cohort of patients with an additive EuroSCORE >/= 6, 67 underwent OPCAB and 112 underwent CCAB.
Results:
Thirty-day postoperative death and stroke rates were 7.5 % and 6.0 % for the OPCAB group, and 5.4 % ( P = 0.75) and 8.0 % ( P = 0.77) for the CCAB group, respectively. No significant differences were observed for other major outcome endpoints other than cardiac troponin I (OPCAB: 117 +/- 428 ng/ml vs. CCAB: 58 +/- 99 ng/ml, P = 0.028), a result which was probably due to preoperative massive myocardial infarction in two very high-risk patients who underwent OPCAB. A similar outcome was also observed among propensity score-matched pairs. Congestive heart failure ( P = 0.006, OR: 6.366, 95 % CI: 1.682 - 24.093) and baseline cardiac index ( P = 0.018, OR: 0.171, 95 % CI: 0.040 - 0.735) were independent predictors of 30-day postoperative mortality.
Conclusions:
OPCAB can be safely performed in high-risk patients with results as satisfactory as those achieved with CCAB.
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