Early outcomes in patients undergoing off-pump coronary artery bypass grafting

In spite of general decline worldwide, off-pump coronary artery bypass grafting (CABG) surgery is performed in more than 60% of patients undergoing CABG in India; mainly because of shorter operative time and reduced procedure cost. However, paucity of data exists in literature about early outcomes following off-pump CABG from India.

We conducted a prospective observational study of 800 consecutive cases that underwent off-pump CABG (OPCAB) from August 2015 to October 2017. Primary end point of the study was the 30-day/in-hospital mortality from any cause.

On multivariate analysis, emergency surgery (OR 9.72; CI 1.96-48.21, p value 0.005), severe left ventricular dysfunction (OR 2.28; CI 1.25-4.76, p value 0.026), postoperative atrial fibrillation (OR 9.95; CI 3.12-32.01, p value 0.05), and dialysis-dependent renal failure (OR 29.7, CI 10.02-87.99, p value 0.006) were the factors associated with mortality. The observed mortality was 1.6%, and the expected mortality by EuroSCORE II was 2.6%. The median EuroSCORE II of expired patients was 3.03 and of entire cohort was 1.54 (p value 0.001). Stroke rate was 0.9%. Deep sternal wound infection occurred in 0.9%, and 3.8% patients were readmitted to the hospital after discharge.

Early outcome of off-pump CABG was excellent in this study. Increased incidence of deep sternal wound infection remains a concern. Multicenter study with a larger sample size is required for a dependable evaluation of the efficacy of off-pump CABG in Indian population.