Fast-track off-pump coronary artery bypass: single-center experience
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Updated: Jan 28, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Chirantan Mangukia1, Mehul Kachhadia1, Manish Meswani1
1NM Virani Wockhardt Hospitals, Rajkot, Gujarat, India.
Insights
Identifying risk factors for prolonged hospital stay after fast-track coronary artery bypass grafting is crucial. Key predictors of fast-track failure include prolonged ventilation and major complications, with 90.2% survival at 66 months.
Area of Science:
- Cardiology
- Thoracic Surgery
- Critical Care Medicine
Background:
- Fast-track cardiac surgery protocols aim to reduce length of stay and improve patient outcomes.
- Coronary artery bypass grafting (CABG) is a common cardiac surgical procedure.
- Identifying factors influencing fast-track success is essential for optimizing patient care.
Purpose of the Study:
- To conduct a retrospective analysis of fast-track CABG at our institution.
- To identify risk factors associated with prolonged hospital stay after fast-track CABG.
- To compare survival statistics with existing literature.
Main Methods:
- Retrospective analysis of 709 patients undergoing fast-track CABG.
- Patients had a mean age of 58.85 years, with 572 males.
- Mean EuroSCORE II was 2.02%; 76% were discharged within 100 hours.
Main Results:
- Prolonged ventilation/reintubation, pulmonary, gastrointestinal, and neurological complications were strong predictors of fast-track failure.
- Other significant risk factors included atrial fibrillation, renal impairment, sternal wound infection, diabetes, preoperative balloon pump use, left ventricular dysfunction, and peripheral arterial disease.
- Cumulative survival at 66 months was 90.2% ± 0.02%.
Conclusions:
- Several factors significantly increase the risk of fast-track failure in CABG patients.
- Smoking cessation can mitigate the impact of chronic obstructive pulmonary disease on fast-track outcomes.
- Survival rates are comparable to those reported in the literature, supporting the efficacy of the protocol.
Aim:
The primary goal of the study was to perform retrospective analysis of fast-track coronary artery bypass grafting at our institute to identify risk factors for prolonged hospital stay. A secondary goal was to identify and compare survival statistics with those published in literature.
Method:
We performed a retrospective analysis of patients enrolled in our fast-track coronary artery bypass protocol. There were 709 patients with a mean age of 58.85 ± 8.9 years; 572 were men. The mean EuroSCORE II was 2.02% ± 2.64%. Of these 709 patients, 538 (76%) met the requirements for discharge within 100 hours.
Results:
Prolonged ventilation or reintubation, major pulmonary complications, gastrointestinal and neurological complications were the strongest predictors of fast-track failure. Persistent atrial fibrillation, postoperative transient renal impairment, requirement for noninvasive ventilation > 3 times, sternal wound infection, insulin-dependent diabetes mellitus, preoperative intraaortic balloon pump for chest pain or ST changes, preoperative severe left ventricular dysfunction, preoperative severe renal impairment, and peripheral arterial disease were also found to be significant risk factors for fast-track failure. Cumulative survival at 66 months of follow-up was 90.2% ± 0.02%.
Conclusion:
The risk factors listed above were associated with fast-track failure. Smoking cessation helps to nullify the factor of chronic obstructive pulmonary disease. Intraoperative elective insertion of a balloon pump does not affect the fast-track protocol. Survival was comparable to that described in the literature.
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