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Outcomes after off-pump reoperative coronary artery bypass grafting

Cullen D Morris1, John D Puskas, Sorin V Pusca

  • 1*Division of Cardiothoracic Surgery, Emory University School of Medicine, and †Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA.

Innovations (Philadelphia, Pa.)
|March 23, 2012
PubMed

Insights

Off-pump (OPCAB) reoperative coronary artery bypass grafting (redo CABG) demonstrated reduced postoperative complications, transfusions, and shorter hospital stays compared to on-pump (ONCAB) procedures in selected patients.

Area of Science:

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

Background:

  • Reoperative coronary artery bypass grafting (redo CABG) presents unique challenges, including technical difficulty and risk of atheromatous embolism.
  • Off-pump coronary artery bypass (OPCAB) techniques have been explored to mitigate these risks, but outcomes compared to traditional on-pump (ONCAB) methods require further investigation.

Purpose of the Study:

  • To compare the clinical outcomes of off-pump (OPCAB) versus on-pump (ONCAB) techniques in patients undergoing reoperative coronary artery bypass grafting (redo CABG).

Main Methods:

  • A retrospective chart review of 771 patients undergoing redo CABG between 1997 and 2004.
  • Comparison of outcomes between OPCAB and ONCAB groups using propensity score matching to adjust for preoperative risk factors.
  • Logistic regression analysis was employed to assess the association between surgical technique and various endpoints.

Main Results:

  • OPCAB was associated with a significant reduction in postoperative complications, need for blood transfusion, incidence of atrial fibrillation, and length of hospital stay compared to ONCAB.
  • Conversion rates were noted: 16.7% from OPCAB to ONCAB and 1.1% from ONCAB to OPCAB.
  • OPCAB patients received fewer grafts, with comparable use of the left internal mammary artery conduit.

Conclusions:

  • Off-pump coronary artery bypass (OPCAB) can be safely and effectively performed in selected patients undergoing reoperative coronary artery bypass grafting (redo CABG).
  • The benefits of OPCAB, including reduced complications and shorter hospital stay, were maintained even when considering conversions to on-pump procedures.
Abstract

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