Off-pump Coronary artery bypass graft surgery in patients with left main stem disease

The safety, feasibility and post-operative outcome are the main concern in Off-pump Coronary artery bypass graft (OPCAB) surgery as compared to conventional technique especially in multi-vessels coronary artery disease.

A cross-sectional study was conducted on 137 patients with left main stem disease (LMS) who underwent Coronary artery bypass graft surgery (CABG) between January 2001 and August 2009 to compare the outcome between off-pump and on-pump CABG.

The mean age was 59.7 ±1.3 years. Off-pump CABG was conducted in 52 (37.95%) and on-pump CABG in 85 (62.05%) cases. There were no significant difference in age, race and BMI between the groups. Off-pump groups had significantly higher EuroSCORE , reduced LVEF, milder left main stem stenosis, lower NYHA score, higher post-operative intra-operative balloon pump insertion (IABP). No significant difference in the number of graft used, LIMA usage and amount of blood loss within the first 24 hours post operatively. More patients in on-pump group had post-operative bleeding (23.5% vs 9.6%, p=0.046) and required more blood product transfusions (p<0.01). There were 3 (5.8%) deaths in off-pump group, 6 (7.1%) in on-pump and 1 (0.7%) in on-pump beating heart groups (p=0.780).

The results of this study showed that Off-pump CABG is equally safe and effective technique for left main stem disease as compared to the conventional on-pump CABG.