Beating Heart versus Conventional Coronary Bypass Surgery: Our Experience

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Thoracic Surgery

Background:

• Off-pump Coronary Artery Bypass (OPCAB) is the standard surgical treatment for Coronary Artery Disease in India.
• OPCAB offers advantages over conventional Coronary Artery Bypass Grafting (CABG) in select patients.
• This study highlights OPCAB experience within the Armed Forces.

Purpose of the Study:

• To compare the perioperative morbidity and mortality of OPCAB versus conventional CABG.
• To evaluate the safety and efficacy of OPCAB as a primary surgical strategy.

Main Methods:

• Retrospective analysis of 200 OPCAB and 200 conventional CABG patients (Jan 2005-Dec 2007).
• Utilized the European system for cardiac operative risk evaluation (euroSCORE).
• Compared perioperative morbidity and mortality between the two groups.

Main Results:

• OPCAB was successful in 96% of patients; 4% required conversion to cardiopulmonary bypass (CPB).
• OPCAB demonstrated lower incidence of reoperation for bleeding, severe bleeding complications, prolonged ventilation, renal replacement therapy, ARDS, and neuropsychiatric manifestations.
• Overall mortality was comparable (1.5% OPCAB vs. 2% CABG), with lower mortality in successfully completed OPCAB cases.

Conclusions:

• OPCAB is safe, effective, and suitable for over 90% of patients undergoing surgical myocardial revascularization.
• OPCAB has lower overall morbidity compared to conventional CABG.
• Hemodynamic instability and difficulty accessing deeply embedded vessels are limitations, favoring conventional CABG in such cases.