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Updated: May 4, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Improved short-term outcomes with off-pump reoperative coronary artery bypass grafting
Basel Ramlawi1, Kareem Bedeir, Luis Garcia-Morales
1From the Houston Methodist DeBakey Heart & Vascular Center, Houston, TX USA.
Insights
Redo off-pump coronary artery bypass (OPCAB) surgery shows better short-term results than on-pump surgery. Patients had fewer postoperative events, less atrial fibrillation, and shorter hospital stays without increased risk.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery Outcomes
Background:
- Reoperative coronary surgery is complex, with patients often being sicker and older.
- Comparisons between on-pump (coronary artery bypass [CAB] surgery on cardiopulmonary bypass [CPB]) and off-pump (OPCAB) techniques are limited in redo cases.
Purpose of the Study:
- To investigate the potential superiority of off-pump coronary artery bypass (OPCAB) versus on-pump coronary artery bypass (CAB) surgery in reoperative settings.
- To compare short-term outcomes between OPCAB and CAB in patients undergoing redo coronary artery bypass grafting.
Main Methods:
- A retrospective analysis of 266 isolated reoperative coronary artery surgeries from January 2004 to July 2011.
- Patients were divided into two groups: CAB on CPB (n=204) and OPCAB (n=62).
- Multivariable analyses were used for risk adjustment to identify independent predictors of outcomes.
Main Results:
- The use of cardiopulmonary bypass (CPB) was an independent predictor of increased postoperative events (OR, 3.9; P=0.004) and atrial fibrillation (OR, 5.9; P<0.005).
- On-pump CAB was associated with longer intensive care unit (P=0.006) and hospital stays (P=0.004).
- Baseline characteristics were similar, though the OPCAB group had higher cerebrovascular disease prevalence and a trend toward fewer vessels bypassed.
Conclusions:
- Redo OPCAB appears to offer favorable short-term outcomes compared to redo CAB surgery.
- OPCAB was associated with reduced overall postoperative events, new-onset atrial fibrillation, and shorter hospital and ICU stays.
- These benefits were observed without an increase in morbidity or mortality, though further randomized trials are warranted.
Objective:
Reoperative coronary surgery patients are usually sicker and older, and the procedure is more technically demanding. Comparisons between coronary surgery with (coronary artery bypass [CAB] surgery on cardiopulmonary bypass [CPB]) and without (off-pump CAB [OPCAB]) the pump have been conducted; however, few studies showed results in reoperative cases. We investigate the potential superiority of one technique over the other in redo coronary surgeries.
Methods:
Our institutional Society of Thoracic Surgery database was used to gather the data for 266 isolated reoperative coronary artery surgeries from January 2004 to July 2011. These were divided into the CAB surgery in CPB group (n = 204) and the OPCAB group (n = 62).
Results:
Baseline characteristics of the two groups were similar, except for a significantly higher prevalence of cerebrovascular disease among the off-pump group (P = 0.01). There was also a trend toward fewer vessels bypassed among the same group (P = 0.07). Risk adjustment was done using multivariable analyses for detection of independent effects. The use of CPB was an independent predictor of increased rates of postoperative events (odds ratio, 3.9; P = 0.004) and atrial fibrillation (odds ratio, 5.9; P < 0.005) and longer intensive care unit (0.006) and hospital stay (0.004).
Conclusions:
Redo OPCAB seems to offer favorable short-term outcomes compared with redo CAB. Our results suggest a reduced rate of overall postoperative events, decreased new postoperative atrial fibrillation, reduced hours stayed in the intensive care unit, and fewer days stayed from surgery to discharge. This was not associated with an increase in morbidity and mortality. A randomized study with a larger number of patients and with a longer follow-up is needed.
