Left anterior descending artery revascularization in low-risk patients: early outcomes after off-pump versus on-pump
Onur Gürer1, Ahmet Kırbaş, Ömer Işık
1Department of Cardiovascular Surgery, Medicana Hospitals Çamlıca, Istanbul, Turkey.
Insights
For low-risk patients with left anterior descending artery disease, both on-pump and off-pump coronary artery bypass grafting show similar early outcomes regarding mortality and morbidity. This comparison of myocardial revascularization techniques highlights comparable safety profiles.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Coronary Artery Disease Management
Background:
- Coronary artery bypass grafting (CABG) is a primary treatment for left anterior descending (LAD) artery stenosis.
- Myocardial revascularization can be performed using cardiopulmonary bypass (on-pump) or without (off-pump).
- Early outcomes of these techniques in specific patient populations require continued investigation.
Purpose of the Study:
- To compare the early postoperative morbidity and mortality of on-pump versus off-pump CABG.
- To evaluate outcomes in patients with isolated or combined LAD and diagonal artery disease.
Main Methods:
- Retrospective review of 300 patients undergoing CABG for LAD stenosis.
- 150 patients in the on-pump group and 150 in the off-pump group.
- Comparison of 30-day mortality and morbidity, including myocardial infarction, stroke, and mediastinitis.
Main Results:
- Hospital mortality was 3.3% (on-pump) vs. 2.6% (off-pump).
- Myocardial infarction rates were 3.3% (on-pump) vs. 2.6% (off-pump).
- Stroke occurred in 1.3% of patients in both groups; mediastinitis in 0.6% of the on-pump group.
Conclusions:
- No significant differences in 30-day morbidity or mortality between on-pump and off-pump CABG in low-risk patients.
- Both surgical approaches offer comparable early outcomes for LAD revascularization in carefully selected patients.
- EuroSCORE criteria were used to define low-risk patients for this comparative analysis.
Background And Aim Of The Study:
This study aimed to compare the early outcomes of off-pump and on-pump myocardial revascularization in patients with stenosis in the left anterior descending artery (alone or with diagonal artery disease).
Methods:
We retrospectively reviewed the medical records of 300 patients: 150 who underwent on-pump coronary artery bypass and 150 who underwent off-pump coronary artery bypass grafting. There were no significant differences between the 2 groups with respect to medical data and operative findings. On-pump and off-pump groups were compared in terms of mortality and morbidity within 30 days of the operation.
Results:
Hospital mortality was 3.3% (5 patients) in the on-pump group and 2.6% (4 patients) in the off-pump group. Five patients (3.3%) in the on-pump group experienced myocardial infarction; 3 died of cardiogenic shock. Four patients (2.6%) in the off-pump group experienced myocardial infarction, and 2 of these patients died. Two patients (1.3%) in the on-pump group and 2 patients (1.3%) in the off-pump group experienced stroke; 1 patient in each group died. One patient (0.6%) in the on-pump group had mediastinitis and died of sepsis.
Conclusions:
Among low-risk patients (defined according to EuroSCORE criteria) who underwent left anterior descending coronary artery bypass, the results obtained with the on-pump and off-pump methods showed no significant differences with respect to morbidity or mortality.
