Total arterial off-pump versus on-pump coronary revascularization: comparison of early outcome

To assess differences in the early outcome after complete arterial myocardial revascularization with (ONCAB) or without cardiopulmonary bypass (OPCAB). Out of 870 consecutive CABG procedures 58 OPCAB and 91 ONCAB patients receiving exclusive arterial grafts were analyzed. OPCAB patients had more sin...

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Bibliographic Details
Published in:Journal of cardiac surgery 2004-11, Vol.19 (6), p.489-494
Main Authors: Berdat, Pascal A, Müller, Karen, Schmidli, Jürg, Kipfer, Beat, Eckstein, Friedrich, Carrel, Thierry
Format: Article
Language:English
Subjects:
Adult
Aged
Anastomosis, Surgical
Biomarkers - blood
Coronary Artery Bypass - adverse effects
Coronary Artery Bypass - methods
Coronary Artery Bypass, Off-Pump - adverse effects
Coronary Artery Bypass, Off-Pump - methods
Coronary Stenosis - metabolism
Coronary Stenosis - surgery
Coronary Vessels - pathology
Coronary Vessels - surgery
Creatine Kinase - metabolism
Female
Humans
Length of Stay
Male
Middle Aged
Retrospective Studies
Time Factors
Treatment Outcome
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Summary:To assess differences in the early outcome after complete arterial myocardial revascularization with (ONCAB) or without cardiopulmonary bypass (OPCAB). Out of 870 consecutive CABG procedures 58 OPCAB and 91 ONCAB patients receiving exclusive arterial grafts were analyzed. OPCAB patients had more single-vessel (p < 0.0001), less triple-vessel (p < 0.0001) or left main disease (p = 0.0021), higher angina class (p = 0.003), unstable angina (p < 0.0001) or previous PTCAs (p < 0.0001). ONCAB was associated with longer operations (182.5 +/- 38 vs. 147 +/- 56 min; p = 0.0001) and more anastomoses/patient (3.2 +/- 1 vs. 2 +/- 0.9; p < 0.0001), but incomplete revascularization was similar in both groups (11% vs. 17%; p = ns). ITA use was identical, whereas single left internal thoracic artery (LITA) use (25.9% vs.1%; p < 0.0001) and LITA jump anastomoses (10.3% vs. 7.7%; p < 0.0001) were more frequent in OPCAB. Radial artery (RA) use (89% vs. 46.6%; p < 0.0001) and RA jump anastomoses (57.1% vs. 12.1%; p < 0.0001) were more frequent in ONCAB. Mortality, arrhythmias, cerebro-vascular accidents (CVA), and renal failure were similar, but ventilatory support shorter (8.8 +/- 11.8 vs. 15.6 +/- 9.4 h; p < 0.0001) and cardiac enzyme release smaller (p < 0.0001) after OPCAB with a trend toward less myocardial infarction (1.7% vs. 7.7%; p = 0.12) and low output (1.7% vs. 8.8%; p = 0.089), and more respiratory complications (10.3% vs. 2.2%; p = 0.056). Arterial OPCAB patients have less extensive CAD, but more severe symptoms. Early outcome is similar concerning mortality, arrhythmias, CVA, renal failure, or ICU and hospital stay, but with shorter ventilatory support and lower cardiac enzymes with a trend toward lower myocardial infarction and low output, but higher respiratory complication rates after OPCAB.
ISSN:0886-0440
1540-8191
DOI:10.1111/j.0886-0440.2004.04104.x