Outcome of coronary artery bypass grafts: comparison between on pump and off pump

Area of Science:

• Cardiac Surgery
• Cardiovascular Medicine
• Surgical Outcomes Research

Background:

• Coronary artery bypass grafting (CABG) is a common surgical procedure for coronary artery disease.
• The use of cardiopulmonary bypass (CPB) during CABG has been debated regarding its impact on patient outcomes.
• Comparing on-pump CABG (ONCABG) with off-pump CABG (OPCABG) is crucial for optimizing surgical strategies.

Purpose of the Study:

• To compare the in-hospital results of ONCABG versus OPCABG.
• To evaluate differences in mortality, graft patency, complication rates, and recovery metrics between the two techniques.

Main Methods:

• A retrospective analysis of 994 first-time isolated CABG procedures (saphenous vein and/or arterial grafts) performed between 2006 and 2009.
• Patients were divided into two groups: ONCABG (n=578) and OPCABG (n=416), with matched age and clinical profiles.
• Exclusion criteria included concomitant cardiac operations or beating-heart techniques.

Main Results:

• Mortality rates were 2.3% for ONCABG and 0.2% for OPCABG.
• OPCABG showed improved post-operative ejection fraction (47.9% vs. 44.53%) and less need for intra-aortic balloon pump (IABP) use (5.4% vs. 1.5%).
• While ONCABG had higher rates of atrial fibrillation, stroke, renal failure, bleeding, and transfusion, these were not statistically significant; however, hospitalization time and inotropic use were lower in the OPCABG group.

Conclusions:

• Off-pump CABG is a safe and effective surgical method, demonstrating favorable clinical and hemodynamic results.
• Patients with similar risk profiles experienced comparable complication rates between ONCABG and OPCABG.
• The study suggests potential benefits of OPCABG in terms of recovery and cardiac function.