Influence of Innovative Techniques on Midterm Results in Patients with Minimally Invasive Direct Coronary Artery Bypass and Off-Pump Coronary Artery Bypass
Background: There is a paucity of midterm results comparing the efficacy of minimally invasive direct coronary artery bypass (MIDCAB) and off-pump coronary artery bypass (OPCAB) with standard coronary artery bypass grafting (CABG). In addition, the advent of innovative techniques may have improved midterm results for patients who undergo MIDCAB and OPCAB (MID-OPCAB). The purpose of this study was to evaluate the midterm survival results of higher-risk patient groups who have undergone CABG or MID-OPCAB with or without the use of innovative techniques.
Methods: From January 1992 through March 2002, 3670 consecutive patients underwent coronary artery bypass procedures, and their predicted surgical risks were calculated according to the logistic EuroSCORE. The cases of 52 MIDCAB patients and 1796 CABG patients with similar higher-risk EuroSCOREs (11.5 versus 11.4, respectively) who underwent operations from January 1992 to December 1997 were compared (study A). The cases of 89 patients with MID-OPCAB (employing "innovative techniques") and 796 patients with CABG (EuroSCORE, 13.2 versus 13.3, respectively) whose operations took place between 1998 and 2002 were also compared (study B). The National Death Index was used to access mortality data, and Kaplan-Meier curves were constructed for each group of patients. Numbers of arterial grafts, numbers of anastomoses, major complications, in-hospital lengths of stay (LOS), and 30-day mortality rates were noted. Results: In study A, there were no significant differences in the 30-day mortality rates (2.5% versus 3.9%), incidences of major complications (11.5% versus 16.6%), and LOS (13 days versus 11.7 days) for the MID-OPCAB and CABG patients, respectively. CABG patients received more arterial grafts (47.1% versus 28.9%; P = .011), received more distal anastomoses (3.4 versus 2.7; P < .001), and had better survival as estimated by Kaplan-Meier curves (94.5 months versus 82.1 months; P = .023). In study B, there were no differences in 30-day mortality rates (3.1% versus 2.3%) and incidences of major complications (10.1% versus 12.7%) for MID-OPCAB and CABG patients, respectively. CABG patients received more arterial grafts (72% versus 57.3%; P = .004) and more distal anastomoses (3.5 versus 2.8; P < .001). However, LOS was shorter for MID-OPCAB patients (7.2 days versus 9.6 days; P = .019), and there was no difference in survival time as estimated by Kaplan-Meier curves (47 months versus 46.4 months; P = .534).
Conclusions: The advent of innovative surgery significantly improved LOS and "equalized" the rate of survival to 5 years in higher-risk MID-OPCAB patients, compared with similar-risk CABG patients.
Ascione R, Lloyd CT, Gomes WJ, et al. 1999. Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized study. Eur J Cardiothorac Surg 15:685-90.nBaumgartner FJ, Gheissari A, Capouya ER, et al. 1999. Technical aspects of total revascularization in off-pump coronary bypass via sternotomy approach. Ann Thorac Surg 67:1653-8.nCleveland JC Jr, Shroyer AL, Chen AY, Peterson E, Grover FL. 2001. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 72:1282-8.nDetter C, Reichenspurner H, Boehm DH, et al. 2002. Minimally invasive direct coronary artery bypass grafting (MIDCAB) and off-pump coronary artery bypass grafting (OPCAB): two techniques for beating heart surgery. Heart Surg Forum 5:157-62.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 115:1273-7.nHaase M, Sharma A, Fielitz A, et al. 2003. On-pump coronary artery surgery versus off-pump exclusive arterial coronary grafting: a matched cohort comparison. Ann Thorac Surg 75:62-7.nYacoub M. 2001. Off-pump coronary bypass surgery: in search of an identity. Circulation 104:1743-5.nYokoyama T, Baumgartner FJ, Gheissari A, et al. 2000. Off-pump versus on-pump coronary bypass in high-risk subgroups. Ann Thorac Surg 70:1546-50.nAbu-Omar Y, Taggart DP. 2002. Off-pump coronary artery bypass grafting. Lancet 360:327-30.nAl Ruzzeh S, Nakamura K, Athanasiou T, et al. 2003. Does off-pump coronary artery bypass (OPCAB) surgery improve the outcome in high-risk patients?: a comparative study of 1398 high-risk patients. Eur J Car diothorac Surg 23:50-5.nAngelini GD, Taylor FC, Reeves BC, Ascione R. 2002. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet 359:1194-9.nArom KV, Flavin TF, Emery RW, et al. 2000. Safety and efficacy of off-pump coronary artery bypass grafting. Ann Thorac Surg 69:704-10.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 71:1477-83.nPuskas JD, Wright CE, Ronson RS, et al. 1999. Clinical outcomes and angiographic patency in 125 consecutive off-pump coronary bypass patients. Heart Surg Forum 2:216-21.nRiha M, Danzmayr M, Nagele G, et al. 2002. Off pump coronary artery bypass grafting in EuroSCORE high and low risk patients. Eur J Cardiothorac Surg 21:193-8.nRose EA. 2003. Off-pump coronary-artery bypass surgery. N Engl J Med 348:379-80.nShennib H. 2001. A renaissance in cardiovascular surgery: endovascular and device-based revascularization. Ann Thorac Surg 72:S993-4.nSpooner TH, Dyrud PE, Monson BK, Dixon GE, Robinson LD. 1998. Coronary artery bypass on the beating heart with the Octopus: a North American experience. Ann Thorac Surg 66:1032-5.nvan Dijk D, Nierich AP, Jansen EW, et al. 2001. Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation 104:1761-6.nHart JC, Spooner TH, Pym J, et al. 2000. A review of 1,582 consecutive Octopus off-pump coronary bypass patients. Ann Thorac Surg 70:1017-20.nMagee MJ, Jablonski KA, Stamou SC, et al. 2002. Elimination of cardiopulmonary bypass improves early survival for multivessel coronary artery bypass patients. Ann Thorac Surg 73:1196-202.nMehran R, Dangas G, Stamou SC, et al. 2000. One-year clinical outcome after minimally invasive direct coronary artery bypass. Circulation 102:2799-802.nMichel P, Roques F, Nashef SAM. 2003. Logistic or additive EuroSCORE for high-risk patients. Eur J Cardiothorac Surg 23:684-7.nNashef SA, Roques F, Hammill BG, et al. 2002. Validation of European System for Cardiac Operative Risk Evaluation (EuroSCORE) in North American cardiac surgery. Eur J Cardiothorac Surg 22:101-5.nNathoe HM, van Dijk D, Jansen EW, et al. 2003. A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients. N Engl J Med 348:394-402.n
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