Multivessel Off-Pump Coronary Artery Bypass: Analysis of 4953 Cases

Authors

  • Zile Singh Meharwal
  • Yugal Kishore Mishra
  • Vijay Kohli
  • Sandeep Singh
  • Ramesh Kumar Bapna
  • Yatin Mehta
  • Naresh Trehan

DOI:

https://doi.org/10.1532/hsf.603

Abstract

Background: To avoid the harmful effects of cardiopulmonary bypass (CPB), cardiac surgeons are using off-pump coronary artery bypass (OPCAB) as an effective alternative to conventional coronary artery bypass grafting (CABG). In the present study, we analyze our results with OPCAB in patients with multivessel coronary artery disease and compare them with those achieved in patients who underwent operations on CPB.

Methods: Between January 1997 and April 2002, 4953 patients underwent CABG without CPB (OPCAB group). These patients were compared with 7133 patients who underwent conventional on-pump CABG (CCAB group) during the same period. All patients were operated on through a median sternotomy. The Octopus was used as the mechanical stabilizer, and intracoronary shunts were used in most patients. Transesophageal echocardiography was used in all patients, and epiaortic scanning was used in selected patients.

Results: The mean patient age was 59 ± 8.9 years in the OPCAB group and 57.4 ± 8.9 years in the CCAB group (P < .001). There were more women in the OPCAB group (11.7% versus 10.4%; P = .023), and 2.8% of the patients required conversion to CPB. The mean numbers of grafts were 3.0 ± 0.7 and 3.2 ± 0.8 in the OPCAB and the CCAB groups, respectively (P < .001). More patients in the CCAB group received grafts to the circumflex territory. Intubation times (19 ± 4 hours versus 25 ± 6 hours; P < .001), blood losses (350 ± 41 mL versus 598 ± 74 mL; P < .001), requirements for blood and blood products (30.8% versus 45.3%; P < .001), the frequency of reopening for bleeding (0.6% versus 2.8%; P < .001), requirements for postoperative intra-aortic balloon pump (1.3% versus 2.6%; P < .001), the frequency of atrial fibrillation (10.9% versus 18.9%; P < .001), and stroke frequency (0.8% versus 1.2%; P = .043) were all significantly lower in the OPCAB group. The mortality rate was 0.97% and 1.86% in the OPCAB and the CCAB groups, respectively (P < .001). Intensive care unit stays (23 ± 6 hours versus 34 ± 8 hours; P < .001) and hospital stays (5 ± 2 days versus 8 ± 3 days; P < .001) were significantly shorter in the OPCAB group.

Conclusion: OPCAB is a safe and effective procedure for patients with multivessel coronary artery disease and is associated with reduced morbidity and mortality. However, large randomized studies with long-term follow-up may show the real benefits of OPCAB compared with CABG on CPB.

References

Naseri E, Arsan S. 1999. Coronary endarterectomy on beating heart. Ann Thorac Surg 68:625-32.nPatel NC, Pullan DM, Fabri BM. 2002. Does off-pump total arterial revascularization without aortic manipulation influence neurological outcome? A study of 226 consecutive, unselected cases. Heart Surg Forum 5:28-32.nPlomondon ME, Cleveland JC Jr, Ludwig ST, et al. 2001. Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes. Ann Thorac Surg 72:114-9.nPuskas JD, Thourani VH, Marshall JJ, et al. 2001. Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients. Ann Thorac Surg 71:1477-84.nPuskas JD, Wright CE, Ronson RS, Brown WM 3rd, Gott JP, Guyton RA. 1998. Off-pump multivessel coronary bypass via sternotomy is safe and effective. Ann Thorac Surg 66:1068-72.nReichenspurner H, Boehm DH, Welz A, et al. 1998. Minimally invasive coronary artery bypass grafting: port-access approach versus off-pump techniques. Ann Thorac Surg 66:1036-40.nBoyd WD, Desai ND, Del Rizzo DF, Novick RJ, McKenzie FN, Menkis AH. 1999. Off-pump surgery decreases postoperative complications and resource utilization in the elderly. Ann Thorac Surg 68:1490-3.nBrasil LA, Gomes WJ, Salomao R, Buffolo E. 1998. Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 66:56-9.nBuffolo E, Andrade JC, Branco JN, Aguiar LF, Ribeiro EE, Jatene AD.1990. Myocardial revascularization without extracorporeal circulation: seven-year experience in 593 cases. Eur J Cardiothorac Surg 4:504-8.nCalafiore AM, Di Mauro M, Contini M, et al. 2001. Myocardial revascularization with and without cardiopulmonary bypass in multivessel disease: impact of the strategy on early outcome. Ann Thorac Surg 72:456-63.nCalafiore AM, Teodori G, Di Giammarco G, et al. 1999. Multiple arterial conduits without cardiopulmonary bypass: early angiographic results. Ann Thorac Surg 67:450-6.nConsten EC, Henny CP, Eijsman L, Dongelmans DA, van Oers MH. 1996. The routine use of fresh frozen plasma in operations with cardiopulmonary bypass is not justified. J Thorac Cardiovasc Surg 112:162-7.nGundry SR, Romano MA, Shattuck OH, Razzouk AJ, Bailey LL. 1998. Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass. J Thorac Cardiovasc Surg 115:1273-8.nRicci M, Karamanoukian HL, Abraham R, et al. 2000. Stroke in octogenarians undergoing coronary artery bypass surgery with and without cardiopulmonary bypass. Ann Thorac Surg 69:1471-5.nRoy A, Stanbridge RL, O'Regan D, et al. 2001. Progression to 100% off-pump coronary artery bypass with the Octopus 1 dual holder. Heart Surg Forum 4:174-8.nWan S, LeClerc JL, Vincent JL. 1997. Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies. Chest 112:676-92.nAnyanwu AC, Al-Ruzzeh S, George SJ, Patel R, Yacoub MH, Amrani M. 2002. Conversion to off-pump coronary bypass without increased morbidity or change in practice. Ann Thorac Surg 73:798-802.nArom KV, Flavin TF, Emery RW, Kshettry VR, Janey PA, Petersen RJ. 2000. Safety and efficacy of off-pump coronary artery bypass grafting. Ann Thorac Surg 69:704-10.nArom KV, Flavin TF, Emery RW, Kshettry VR, Petersen RJ, Janey PA. 2000. Is low ejection fraction safe for off-pump coronary bypass operation? Ann Thorac Surg 70:1021-5.nAscione R, Lloyd CT, Underwood MJ, Lotto AA, Pitsis AA, Angelini GD. 1999. Economic outcome of off-pump coronary artery bypass surgery: a prospective randomized study. Ann Thorac Surg 68:2237-42.nAscione R, Williams S, Lloyd CT, Sundaramoorthi T, Pitsis AA, Angelini GD. 2001. Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: a prospective randomized study. J Thorac Cardiovasc Surg 121:689-96.nBenetti FJ, Naselli G, Wood M, Geffner L. 1991. Direct myocardial revascularization without extracorporeal circulation: experience in 700 patients. Chest 100:312-6.nKolessov VI. 1967. Mammary artery-coronary artery anastomosis as method of treatment for angina pectoris. J Thorac Cardiovasc Surg 54:535-44.nLucchetti V, Capasso F, Caputo M, et al. 1999. Intracoronary shunt prevents left ventricular function impairment during beating heart coronary revascularization. Eur J Cardiothorac Surg 15:255-9.nMack M, Bachand D, Accuff T, et al. 2002. Improved outcomes in coronary artery bypass grafting with beating-heart techniques. J Thorac Cardiovasc Surg 124:598-607.nMathison M, Edgerton JR, Horswell JL, Akin JJ, Mack MJ. 2000. Analysis of hemodynamic changes during beating heart surgical procedures. Ann Thorac Surg 70:1355-61.nHart JC, Spooner TH, Pym J, et al. 2000. A review of 1,582 consecutive Octopus off-pump coronary bypass patients. Ann Thorac Surg70:1017-20.nHernandez F, Cohn WE, Baribeau YR, et al. 2001. In-hospital outcomes of off-pump versus on-pump coronary artery bypass procedures: a multi-center experience. Ann Thorac Surg 72:1528-34.nIzzat MB, Yim AP. 1997. Minimally invasive LAD revascularisation in high-risk patients with three-vessel coronary artery disease. Int J Cardiol 62(suppl 1):S101-4.n

Published

2005-02-07

How to Cite

Meharwal, Z. S., Mishra, Y. K., Kohli, V., Singh, S., Bapna, R. K., Mehta, Y., & Trehan, N. (2005). Multivessel Off-Pump Coronary Artery Bypass: Analysis of 4953 Cases. The Heart Surgery Forum, 6(3), 153-159. https://doi.org/10.1532/hsf.603

Issue

Section

Article