Off-pump technique: a systematic alternative for myocardial revascularization?

Many studies failed to show that off-pump myocardial revascularization achieved better results than on-pump revascularization, and also invited a lot of criticism for the criteria used for selection and inclusion of patients. To avoid these limitations, we systematically treated all candidates for coronary surgery with this technique evaluating early and follow-up results.

In 257 prospective consecutive patients, off-pump myocardial revascularization was performed by the same surgeon without any exclusion criteria. Hospital mortality and main postoperative complications were analysed. After a mean follow-up of 27.50 months, 245 patients (98.4%) were contacted to evaluate late mortality, recurrence of angina, myocardial infarction and need for new revascularization.

Conversion to extracorporeal circulation was necessary in 10 cases. Hospital mortality was eight patients (3.11%). Postoperative complications were reexploration for bleeding (2.72%), myocardial infarction (1.17%), atrial fibrillation (21.01%), stroke (0.39%) and renal failure (3.5%). Follow-up overall mortality was 16 patients (6.53%) with two cardiac-related deaths (0.82%). Total cardiac events at follow-up occurred in 20 patients (8.16%). There were two cardiac deaths, angina in 15 cases, silent myocardial ischaemia in two and myocardial infarction in one. New revascularization procedures were necessary in seven cases (2.86%). Statistical results showed that the European System for Cardiac Operative Risk Evaluation rate was predictor of 30-day and overall mortality. Multivariate analysis showed that age was a predictor of overall mortality whereas female sex was a predictor of cardiac events.

In conclusion, systematic off-pump surgery was not associated with a higher rate of mortality, morbidity and cardiac events compared to on-pump technique.