Clinical Outcomes and Angiographic Patency in 125 Consecutive Off-Pump Coronary Bypass Patients

(#1999-95310 ... May 21, 1999)

John D. Puskas, MD, Carolyn E. Wright, MS, Russell S. Ronson, MD, W. Morris Brown, III, MD, John Parker Gott, MD, Robert A. Guyton, MD

Carlyle Fraser Heart Center, Crawford Long Hospital of Emory University, Atlanta, Georgia, USA

ABSTRACT

Background: This study compared clinical outcomes, length of stay, and hospital costs in patients having off-pump coronary bypass (OPCAB) versus conventional bypass surgery (CABG).

Methods: From November 1996 through April 9, 1999, OPCAB was performed for 125 consecutive patients and compared with a contemporaneous, matched control group of 625 CABG patients. Patients were matched according to age, gender, incidence of renal failure, diabetes, pulmonary disease, stroke (CVA), hypertension, peripheral vascular disease, and previous myocardial infarction. Follow-up in the OPCAB patients was 100% and averaged 15 months.

Results: An average of 2.0 grafts per patient were performed in the OPCAB group (range 1-5). Ninety-four OPCAB patients (75.2%) had a total of 179 grafts assessed angiographically prior to hospital discharge. All but 4/179 grafts (2.2%) were patent , including 94 of 94 IMA grafts (100%) . There were no in-hospital deaths in the OPCAB group compared to a mortality rate of 1.4% in the CABG group. OPCAB reduced postoperative hospital stay from 5.5 days in the traditional CABG group to 3.3 days (p=.002), with a decrease in hospital cost of 24% (p=.01). In addition, there was a significant reduction in the rate of transfusion in the OPCAB group (29.6%) compared to the CABG group (56.5%, p=.0001). Two OPCAB patients required postoperative intervention to improve graft patency during the follow-up period. No internal mammary grafts required revision. There was one perioperative CVA and one myocardial infarction in the OPCAB group.

Conclusions: OPCAB surgery reduces hospital cost, postoperative length of stay , and transfusion rate compared to CABG. OPCAB is safe, cost effective, and associated with excellent graft patency and clinical outcomes.

AUTHOR/ARTICLE INFORMATION

Presented at the Annual Meeting of the International Society for Minimally Invasive Cardiac Surgery, Palais dés Congres, Paris, France , May 21-22, 1999.

Reprint requests to: John D. Puskas, MD, MSc, Assistant Professor of Surgery, Emory University, Carlyle Fraser Heart Center, Crawford Long Hospital, 550 Peachtree Street, NE, Suite 7700, Atlanta, GA 30365; Phone: 404-686-2513; Fax: 404-686-4959; e-mail address: jpuskas@emory.edu

Submitted on: Peer reviewed and accepted at the International Society for Minimally Invasive Cardiac Surgery's 2nd Annual Meeting and Scientific Sessions, Paris, France, May 21-22 1999.