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

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Minimally Invasive Cardiac Procedures

Background:

• Off-pump myocardial revascularization (OPCAB) has faced scrutiny due to patient selection criteria in prior studies.
• Previous research yielded mixed results comparing OPCAB to on-pump coronary artery bypass grafting (CABG).

Purpose of the Study:

• To evaluate the early and follow-up results of OPCAB performed systematically on all coronary surgery candidates.
• To address limitations of previous studies by removing exclusion criteria for OPCAB.

Main Methods:

• A prospective study of 257 consecutive patients undergoing OPCAB by a single surgeon, with no exclusion criteria.
• Analysis of hospital mortality, postoperative complications, and long-term outcomes including mortality, angina recurrence, myocardial infarction, and need for revascularization.
• Mean follow-up of 27.50 months, with 98.4% patient contact rate.

Main Results:

• Hospital mortality was 3.11% (8 patients); overall mortality at follow-up was 6.53% (16 patients).
• Major postoperative complications included bleeding (2.72%), myocardial infarction (1.17%), and atrial fibrillation (21.01%).
• Total cardiac events at follow-up were 8.16% (20 patients), with 2.86% requiring new revascularization. European System for Cardiac Operative Risk Evaluation (EuroSCORE) predicted mortality; age and female sex predicted adverse outcomes.

Conclusions:

• Systematic OPCAB is a viable alternative to on-pump CABG, showing no increased mortality, morbidity, or cardiac event rates.
• The study supports OPCAB as a safe and effective strategy for a broad range of coronary surgery patients.
• Risk stratification using EuroSCORE and consideration of patient age and sex are important for predicting outcomes in OPCAB.