Early and midterm results of off-pump coronary artery bypass grafting without patient selection

Many reports have addressed the technical feasibility and early clinical results of off-pump coronary artery bypass grafting (OPCABG). It is uncertain, however, whether OPCABG provides midterm results equivalent to those of conventional CABG.

At Shiga University of Medical Science Hospital from January 2002 to May 2007, 477 consecutive patients underwent isolated OPCABG myocardial revascularization performed by a single surgeon (T.A.). OPCABG surgery was performed on all patients, with no exclusion criteria. These 477 patients were followed up for time-related events, including death from all causes, cardiac death, myocardial infarction, percutaneous coronary intervention, reoperation, and the combined end-point of cardiac events. Follow-up was completed in 96.0% of the patients (458 of 477).

The number of distal anastomoses per patient was 3.46 + or - 0.9, and complete revascularization was achieved in 96.6% of patients. No patient required conversion from off-pump to on-pump surgery. The average operation time was 272 +/- 63 minutes. Thirteen patients (2.9%) required reoperation for bleeding. Deep sternal infection occurred in 5 patients (1.1%). One patient (0.2%) had a stroke and 4 patients (0.9%) had perioperative myocardial infarction. Acute renal failure requiring hemodialysis occurred in 10 patients (2.2%). Overall 30-day mortality was 1.1% (5 of 477). Follow-up was completed in 96.0% of patients. Mean follow-up was 3.0 +/- 1.3 years. Five-year freedom from death from any cause was 79.1%, freedom from cardiac death 93.4%, and freedom from the combined end-point of cardiac death, myocardial infarction, repeat coronary intervention, and heart failure was 75.8%.

Our results demonstrate the safety of performing OPCABG surgery in all patients, without the use of exclusion criteria. Early and midterm outcomes were acceptable and encouraged continued use of the OPCABG approach in all CABG patients.