Clinical Outcomes of Coronary Revascularization without Cardiopulmonary Bypass
DOI:
https://doi.org/10.1532/hsf.801Abstract
Objective: Coronary artery bypass without cardiopulmonary bypass (OPCAB) eliminates the complications related to cardiopulmonary bypass. However, the long-term outcomes of this procedure are largely unknown.
Methods: We sought to investigate the rates of late mortality, stroke, acute myocardial infarction, and target vessel reintervention after OPCAB in a consecutive series of 857 patients who underwent OPCAB between May 1987 and March 1999.
Results: Long-term follow-up was obtained for 86% of eligible patients. Actuarial and event-free survival was 89% and 76%, respectively, for a median follow-up period of 2.2 years (range, 0-13.3 years). Risk factors for late mortality were identified with Cox regression analysis. In the multivariate analysis, patient age >75 years (odds ratio, 1.1; 95% confidence interval, 1.0-1.1; P = .01) and an ejection fraction <35% (odds ratio, 2.7; 95% confidence interval, 1.2-6.2; P = .02) emerged as independent predictors of late mortality.
Conclusion: OPCAB is associated with a low mortality and clinical event rate. Advanced age and depressed ejection fraction may increase mortality after OPCAB.
References
Allen KB, Matheny RG, Robinson RJ, Heimansohn DA, Shaar CJ. 1997. Minimally invasive versus conventional reoperative coronary artery bypass. Ann Thorac Surg 64:616-22.nBerger PB, Alderman EL, Nadel A, Schaff HV. 1999. Frequency of early occlusion and stenosis in a left internal mammary artery to left anterior descending artery bypass graft after surgery through a median sternotomy on conventional bypass: benchmark for minimally invasive direct coronary artery bypass. Circulation 100:2353-8.nBhaskerRao B, VanHimbergen D, Edmonds HL Jr, et al. 1998. Evidence for improved cerebral function after minimally invasive bypass surgery. J Card Surg 13:27-31.nCernaianu AC, Vassilidze TV, Flum DR, et al. 1995. Predictors of stroke after cardiac surgery. J Card Surg 10:334-9.nFitzGibbon GM, Burton JR, Leach AJ. 1978. Coronary bypass graft fate: angiographic grading of 1400 consecutive grafts early after operation and of 1132 after one year. Circulation 57:1070-4.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.nHerlitz J, Brandrup-Wognsen G, Karlson BW, et al. 2000. Mortality, risk indicators for death, and mode of death in younger and elderly patients during five years after coronary artery bypass graft. Clin Cardiol 23:421-6.nLancey RA, Babs RS, Vander Salm TJ. 2001. Off-pump versus on-pump coronary artery bypass surgery: a case-matched comparison of clinical outcomes and costs. Heart Surg Forum 3:277-81.nLytle BW. 1996. Minimally invasive cardiac surgery. J Thorac Cardiovasc Surg 111:554-5.nMagee MJ, Jablonski KA, Stamou SC, et al. 2002. Elimination of cardiopulmonary bypass improves early survival in multivessel coronary artery bypass patients. Ann Thorac Surg 73:1196-203.nMehran R, Dangas G, Stamou SC, et al. 2000. One year clinical outcome after minimally invasive direct coronary artery bypass. Circulation 102:2799-802.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.nStamou SC, Corso PJ. 2001. Coronary revascularization in high-risk patients: a route to the future. Ann Thorac Surg 71:1056-61.nStamou SC, Pfister AJ, Dangas G, et al. 2000. Beating heart versus conventional single vessel reoperative coronary artery bypass surgery. Ann Thorac Surg 69:1383-7.nStanbridge RD, Hadjinikolaou LK, Cohen AS, Foale RA, Davies WD, Kutoubi AA. 1997. Minimally invasive coronary revascularization through parasternal incisions without cardiopulmonary bypass. Ann Thorac Surg 63:S53-6.nSubramanian V. 1999. Minimally invasive coronary artery bypass grafting on the beating heart: the American experience. In: Oz MC, Goldstein DJ, editors. Minimally invasive cardiac surgery. Totowa, NJ: Humana Press. p 89-103. Ullyot DJ. 1996. Look ma, no hands! Ann Thorac Surg 61:10-1.n