Long-Term Outcomes after Redo Coronary Artery Bypass Grafting: A Propensity-Matched Analysis of On-Pump and Off-Pump...

Area of Science:

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

Background:

• Redo coronary artery bypass grafting (redo-CABG) presents significant technical challenges and increased perioperative risks compared to primary CABG.
• The benefit of avoiding cardiopulmonary bypass (CPB) during redo-CABG remains an area of active investigation.
• Optimizing surgical strategies for redo-CABG is crucial for improving patient outcomes.

Purpose of the Study:

• To compare the perioperative and long-term outcomes of off-pump versus on-pump redo-CABG.
• To evaluate the safety and efficacy of different bypass strategies in a high-volume surgical center.
• To identify predictors of survival following redo-CABG.

Main Methods:

• Retrospective analysis of 370 patients undergoing redo-CABG between 2009 and 2024.
• Propensity score matching was utilized to balance preoperative covariates between off-pump and on-pump groups.
• Survival analyses and assessment of revascularization completeness were performed.

Main Results:

• Off-pump redo-CABG was associated with significantly shorter operative times and reduced red blood cell transfusion requirements.
• Lower levels of myocardial injury biomarkers (CK-MB, troponin) were observed in the off-pump group.
• In-hospital mortality, stroke, myocardial infarction, and long-term survival rates were comparable between the off-pump and on-pump strategies.

Conclusions:

• Off-pump redo-CABG is a safe and effective alternative to on-pump surgery, with similar long-term outcomes.
• The choice between off-pump and on-pump strategies for redo-CABG should be individualized based on patient-specific factors and surgeon expertise.
• Surgical strategy alone was not an independent predictor of long-term survival in multivariable analysis.