Early and Midterm Results after Coronary Artery Bypass Grafting with and without Cardiopulmonary Bypass: Which Patient Population Benefits the Most?
Background: We present our early and midterm results with off-pump coronary artery bypass grafting (OPCAB) on the beating heart and with conventional coronary artery bypass grafting (CABG) and compare patient outcomes for both procedures.
Methods: Between November 1997 and April 2001, OPCAB was performed in 330 patients. The results were compared with those of a matched population of 330 patients who had undergone CABG during the same period. Specific postoperative outcomes were evaluated for patient subgroups with multimorbidity, with impaired ventricular function, of an older age, and of a young age without comorbidities. Midterm results and quality-of-life (QOL) scores for patients were obtained by follow-up.
Results: In the overall series, OPCAB resulted in significantly shorter surgery times (P = .008), ventilation times (P < .001), intensive care unit (ICU) stays (P < .001), and hospital stays (P = .006). OPCAB also resulted in less postoperative inotropic medication (P = .041), lower transfusion rates (P < .001), fewer postoperative myocardial infarctions (P = .038), and lower hospital mortality rates (P = .024). Among the patient subgroups, patients with multimorbidities were the only subgroup to show a significant reduction in hospital mortality after OPCAB surgery (P = .048). Times of postoperative ventilation, ICU stay, and hospitalization were significantly reduced for all patient subgroups (P < .05). After mean followup times of 43.8 months (OPCAB) and 44.8 months (CABG), QOL scores, midterm complication rates, and mortality rates were not significantly different among the groups. Conclusion: OPCAB surgery improved postoperative recovery for the entire patient population without compromising midterm outcome. Compared with conventional CABG, high-risk patients with multimorbidity particularly profit from avoiding cardiopulmonary bypass and show significantly lower hospital mortality.
Al-Ruzzeh S, George S, Yacoub M, Amrani M. 2001. The clinical outcome of off-pump coronary artery bypass surgery in the elderly patients. Eur J Cardiothorac Surg 20:1152-6.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.nAscione R, Lloyd CT, Underwood MJ, Gomes WJ, Angelini GD. 1999. On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg 68:493-8.nAsimakopoulos G, Smith PL, Ratnatunga CP, Taylor KM. 1999. Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg 68:1107-15.nBouchart F, Tabley A, Litzler PY, Haas-Hubscher C, Bessou JP, Soyer R. 2001. Myocardial revascularization in patients with severe ischemic left ventricular dysfunction. Long term follow-up in 141 patients. Eur J Cardiothorac Surg 20:1157-62.nBull DA, Neumayer LA, Stringham JC, Meldrum P, Affleck DK, Karwande SV. 2001. Coronary artery bypass grafting with cardiopulmonary bypass versus off-pump cardiopulmonary bypass grafting: does eliminating the pump reduce morbidity and cost? Ann Thorac Surg 71:170-3.nCartier R, Brann S, Dagenais F, Martineau R, Couturier A. 2000. Systematic off-pump coronary artery revascularization in multivessel disease: experience of three hundred cases. J Thorac Cardiovasc Surg 119:221-9.nCleveland JC, 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.nCzerny M, Baumer H, Kilo J, et al. 2000. Inflammatory response and myocardial injury following coronary artery bypass grafting with or without cardiopulmonary bypass. Eur J Cardiothorac Surg 17:737-42.nDetter C, Deuse T, Christ F, Boehm DH, Reichenspurner H, Reichart B. 2002. Comparison of two different stabilizer concepts for off-pump coronary artery bypass surgery. Ann Thorac Surg 74:497-501.nDetter C, Reichenspurner H, Boehm DH, Thalhammer M, Schutz A, Reichart B. 2001. Single vessel revascularization with beating heart techniques: minithoracotomy or sternotomy? Eur J Cardiothorac Surg 19:464-70.nDiegeler A, Falk V, Matin M, et al. 1998. Minimally invasive coronary artery bypass grafting without cardiopulmonary bypass: early experience and follow-up. Ann Thorac Surg 66:1022-5.nGrundeman PF, Borst C, Verlaan CW, Meijburg H, Moues CM, Jansen EW. 1999. Exposure of circumflex branches in the tilted, beating porcine heart: echocardiographic evidence of right ventricular deformation and the effect of right or left heart bypass. J Thorac Cardiovasc Surg 118:316-23.nHart JC. 2001. A review of 140 Octopus off-pump bypass patients over the age of seventy: procedure of choice? Heart Surg Forum 4(suppl 1): S24-9.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.nHartmann GS, Yao GS, Bruefach M. 1996. Severity of aortic atheromatous disease diagnosed by transesophageal echocardiography predicts stroke and other outcomes associated with coronary artery surgery: a prospective study. Anesth Analg 83:701-8.nJansen EWL, Borst C, Lahpor JR, et al. 1998. Coronary artery bypass grafting without cardiopulmonary bypass using the Octopus method: results in the first one hundred patients. J Thorac Cardiovasc Surg 116:60-7.nKirk KC, Aldridge RA, Sistino JJ, et al. 2001. Coronary artery bypass grafting with and without cardiopulmonary bypass: a comparison analysis. J Extra Corpor Technol 33:86-90.nWan S, Izzat MB, Lee TW, Wan I, Tang N, Yim A. 1999. Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and myocardial injury. Ann Thorac Surg 68:52-7.nWare JE Jr, Kosinski M, Gandek B, et al. 1998. The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project: International Quality of Life Assessment. J Clin Epidemiol 51:1159-65.nWoodman RC, Harker LA. 1990. Bleeding complications associated with cardiopulmonary bypass. Blood 76:1680-97.nYeatman M, Caputo M, Ascione R, Ciulli F, Angelini GD. 2001. Off-pump coronary artery bypass surgery for critical left main stem disease: safety, efficacy and outcome. Eur J Cardiothorac Surg 19:239-44.nYokoyama T, Baumgartner FJ, Gheissari A, Capouya ER, Panagiotides GP, Declusin RJ. 2000. Off-pump versus on-pump coronary bypass in high-risk subgroups. Ann Thorac Surg 70:1546-50.nKoh TW, Carr-White GS, DeSouza AC, et al. 1999. Intraoperative cardiac troponin T release and lactate metabolism during coronary artery surgery: comparison of beating heart with conventional coronary artery surgery with cardiopulmonary bypass. Heart 81:495-500.nKoutlas TC, Elbeery JR, Williams JM, Moran JF, Francalancia NA, Chitwood WR. 2000. Myocardial revascularization in the elderly using beating heart coronary artery bypass surgery. Ann Thorac Surg 69:1042-7.nLancey RA, Soller BR, Vander Salm TJ. 2000. Off-pump versus on-pump coronary artery bypass surgery: a case-matched comparison of clinical outcomes and costs. Heart Surg Forum 3:277-81.nLocker C, Shapira I, Paz Y, et al. 2000. Emergency myocardial revascularization for acute myocardial infarction: survival benefits of avoiding cardiopulmonary bypass. Eur J Cardiothorac Surg 17:234-8.nStamou SC, Corso PJ. 2001. Coronary revascularization without cardiopulmonary bypass in high-risk patients: a route to the future. Ann Thorac Surg 71:1056-61.nTaylor KM. 1998. Central nervous system effects of cardiopulmonary bypass. Ann Thorac Surg 66:S20-4.n
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