Clinical Outcomes in Coronary Artery Bypass Graft Surgery: Comparison of Off-Pump and On-Pump Techniques

(#2002-77889 ... March 22, 2002)

Vipin Y. Zamvar, FRCS(CTh), Nouman U. Khan, FRCS, Anil Madhavan, FRCS, Nihal Kulatilake, FRCS, Eric G. Butchart, FRCS

University Hospital of Wales, Cardiff, UK

ABSTRACT

Background: A consecutive series of patients undergoing first-time coronary artery bypass graft (CABG) surgery were analyzed and the impact of off-pump surgery was evaluated.

Methods: From January 1, 2000 to December 31, 2000, 367 patients underwent isolated first-time CABG surgery. One hundred and twenty underwent off-pump CABG (Group A, 32.7%) and 247 underwent conventional on-pump CABG (Group B, 67.3%). Five patients were converted during operation and were included in Group A. The pre-operative characteristics, intra-operative details, and post-operative course were analyzed in the two groups. All patients were followed up between 11 and 23 months (median 18 months) after operation by telephone interviews or questionnaire survey.

Results: Early mortality was 2.1% (group A, 0.83%; group B, 2.83%), with the difference not being statistically significant. The incidence of post-op stroke (group A, 1.66%; group B, 3.66%), renal failure (group A, 2.5%; group B, 5.66%), and gastrointestinal complications (group A, 1.66%; group B, 1.21%) was likewise not significantly different in the two groups. However, the patients in group A had a statistically significant lower incidence of low cardiac-output (group A 13.3%; group B 29.5%; p = 0.002), atrial fibrillation (group A 11.66%; group B 30.36%; p<0.001), blood product transfusion (group A 39.66%; group B 89.87%; p<0.001), time on ventilator (group A, 5.96 hrs; group B, 10.31 hrs; p<0.001), and post-op hospital stay (group A, 7.79 days; group B, 9.81 days, p<0.001). Medium-term results (recurrence of angina, late mortality, cardiovascular events, and need for revascularization) were similar in the two groups.

Conclusions: Off-pump CABG results in a decreased incidence of complications in the immediate post-op period with comparable results in the medium term.