On-pump beating heart versus off-pump myocardial revascularization-a propensity-matched comparison

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Minimally Invasive Cardiac Surgery

Background:

• On-pump beating heart coronary artery bypass grafting (OP-BH CABG) is an alternative to off-pump coronary artery bypass (OPCAB) and conventional on-pump coronary artery bypass grafting (On-pump CABG), particularly in India.
• Limited outcome data exists for OP-BH CABG procedures.
• This study addresses the need for comparative outcome data between OP-BH CABG and OPCAB.

Purpose of the Study:

• To compare the clinical outcomes of OP-BH CABG with OPCAB.
• To evaluate the safety and efficacy of OP-BH CABG versus OPCAB.

Main Methods:

• A retrospective analysis of patients undergoing OP-BH CABG (n=531) from an institutional database.
• A propensity-matched cohort of patients undergoing OPCAB (n=531) was identified using nearest neighbor matching.
• Matching criteria included age, gender, BMI, EuroSCORE, recent myocardial infarction/unstable angina, hypertension, PVD, COPD, diabetes, pre-op renal impairment, pre-op neurological events, and LV function.

Main Results:

• Propensity-matched groups demonstrated comparable baseline characteristics, with mean EuroSCORE of 3.17 (OP-BH) and 3.20 (OPCAB).
• Unadjusted 30-day mortality was significantly higher in the OP-BH CABG group (6.9%) compared to the OPCAB group (2.07%).
• Multivariate analysis identified OP-BH CABG as an independent risk factor for 30-day mortality and major adverse post-operative outcomes (renal, neurological, respiratory, and atrial fibrillation).

Conclusions:

• OP-BH CABG is associated with significantly worse clinical outcomes compared to OPCAB.
• The findings suggest that OPCAB may offer superior short-term results.
• Further research may be warranted to explore strategies to mitigate the risks associated with OP-BH CABG.