On-pump beating-heart coronary artery bypass: a propensity matched analysis

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes

Background:

• The impact of cardioplegic arrest on surgical outcomes following coronary artery bypass grafting (CABG) remains incompletely understood.
• This study investigates and compares early outcomes between on-pump beating-heart CABG and conventional CABG procedures.

Purpose of the Study:

• To compare the early clinical outcomes of on-pump beating-heart CABG versus conventional CABG.
• To identify patient characteristics influencing the choice between on-pump beating-heart CABG and conventional CABG.

Main Methods:

• A cohort of 114 patients undergoing on-pump beating-heart CABG (2002-2005) was compared to 114 propensity score-matched conventional CABG patients.
• Multivariate logistic regression identified predictors for technique selection: history of cerebral infarction, urgent operation, low ejection fraction, elevated creatine kinase, and fewer diseased vessels.

Main Results:

• On-pump beating-heart CABG demonstrated significantly reduced operation time, cardiopulmonary bypass duration, blood loss, and peak creatine kinase levels.
• Fewer patients required intra-aortic balloon pump support (2 vs. 13) or percutaneous cardiopulmonary support (0 vs. 4) after on-pump beating-heart CABG.
• While complete revascularization was lower (42.1% vs. 77.2%), in-hospital mortality was also reduced (2.6% vs. 9.6%) in the on-pump beating-heart group; no significant differences in stroke, renal failure, or mediastinitis were observed.

Conclusions:

• On-pump beating-heart CABG is a safe surgical option, even for high-risk individuals.
• The benefits of cardiopulmonary bypass and avoidance of cardioplegic arrest appear most advantageous for hemodynamically unstable patients.