Surgical outcome after isolated on-pump and off-pump anterior descending coronary revascularisation

Anterior descending coronary revascularisation can be performed with or without cardiopulmonary bypass. We compared surgical outcomes and postoperative results of two groups of patients operated on for isolated anterior descending coronary revascularisation with the left internal mammary artery, in order to determine the ideal target patient of each technique.

From July 1997 to December 2012, 243 consecutive patients underwent off-pump (119) or on-pump (124) surgery for isolated revascularisation of the anterior descending coronary artery. We retrospectively collected, analysed and compared preoperative, intraoperative and postoperative variables.

In the on-pump group, aortic cross-clamp and bypass times were 22 and 35 minutes, respectively. Mean surgical time was 126 minutes for the off-pump group and 160 minutes for the on-pump group. Off-pump patients were more often men (82% vs 66%, p = 0.006), older (median age 67 vs 64 years, p = 0.013), with renal failure (11% vs 2.4%, p = 0.009) and respiratory failure (20% vs 7.3%, p = 0.003), with peripheral vascular disease (17% vs 8%, p = 0.038) and affected by a higher degree of angina (p <0.001). Surgical time was shorter off-pump (p <0.001), but a greater number of urgent procedures were performed on-pump (11% vs 3.4%, p = 0.042). No difference in postoperative characteristics and complications except for the intensive care unit stay, which was shorter off-pump (median 1 vs 2 days, p = 0.046). Hospital mortality was 0.8% off-pump and 1.6% on-pump (p = 0.5).

Both on-pump and off-pump surgery for isolated anterior descending coronary revascularization are safe with equal surgical risk. Off-pump procedures seem to be more appropriate in nonurgent patients with higher surgical risk profiles.