Incidence and Outcomes of Pneumonia after Isolated Off-Pump Coronary Artery Bypass Grafting


  • Toshihiro Fukui
  • Susumu Manabe
  • Tomoki Shimokawa
  • Shuichiro Takanashi



Background: Pneumonia is a major complication of cardiac surgery, with cardiopulmonary bypass considered one of the causes of pulmonary dysfunction. The incidence of pneumonia has decreased with improved surgical techniques and postoperative management; however, the incidence and outcome of pneumonia after off-pump coronary artery bypass grafting (OPCAB) are largely unknown.

Methods: We retrospectively reviewed the records of 719 patients who underwent isolated OPCAB between September 2004 and June 2008. Pneumonia was confirmed with a chest radiograph or by computed tomography. We compared preoperative and postoperative variables for patients with and without pneumonia, and for patients with postoperative pneumonia who died from pneumonia and those who survived.

Results: We identified 11 patients (1.5%) as having pneumonia after OPCAB. The most frequently observed organism in patients with postoperative pneumonia was Klebsiella. There were no significant differences between patients with pneumonia and those without pneumonia with respect to age (75.5 ± 7.1 years versus 67.8 ± 10.0 years; P = .0724), prior myocardial infarction (72.7% versus 47.5%; P = .0792), or postoperative intubation time (16.2 ± 15.1 hours versus 10.2 ± 16.0 hours; P = .2781). The operative mortality rate (within 30 days) was significantly higher in patients with pneumonia (36.4% versus 0%; P< .0001).

Conclusion: The incidence of pneumonia after OPCAB is low, although pneumonia remains one of most devastating complications after OPCAB.


Asimakopoulos G, Smith PL, Ratnatunga CP, Taylor KM. 1999. Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg 68:1107-15.nCarrel TP, Eisinger E, Vogt M, Turina MI. 2001. Pneumonia after cardiac surgery is predictable by tracheal aspirates but cannot be prevented by prolonged antibiotic prophylaxis. Ann Thorac Surg 72:143-8.nCheng DC, Bainbridge D, Martin JE, Novick RJ, Evidence-Based Perioperative Clinical Outcomes Research Group. 2005. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology 102:188-203.nEdwards FH, Engelman RM, Houck P, Shahian DM, Bridges CR. 2006. The Society of Thoracic Surgeons Practice Guideline Series: antibiotic prophylaxis in cardiac surgery, part I: duration. Ann Thorac Surg 81:397-404.nFukui T, Takanashi S, Hosoda Y, Suehiro S. 2007. Early and midterm results of off-pump coronary artery bypass grafting. Ann Thorac Surg 83:115-9.nFukui T, Takanashi S, Hosoda Y. 2005. Long segmental reconstruction of diffusely diseased left anterior descending coronary artery with left internal thoracic artery with or without endarterectomy. Ann Thorac Surg 80:2098-105.nGaynes R, Bizek B, Mowry-Hanley J, Kirsh M. 1991. Risk factors for nosocomial pneumonia after coronary artery bypass graft operations. Ann Thorac Surg 51:215-8.nLaffey JG, Boylan JF, Cheng DC. 2002. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology 97:215-52.nLauruschkat AH, Arnrich B, Albert AA, et al. 2008. Diabetes mellitus as a risk factor for pulmonary complications after coronary bypass surgery. J Thorac Cardiovasc Surg 135:1047-53.nMenasché P. 2001. The systemic factor: the comparative roles of cardiopulmonary bypass and off-pump surgery in the genesis of patient injury during and following cardiac surgery. Ann Thorac Surg 72:S2260-5.nMontes FR, Maldonado JD, Paez S, Ariza F. 2004. Off-pump versus on-pump coronary artery bypass surgery and postoperative pulmonary dysfunction. J Cardiothorac Vasc Anesth 18:698-703.nStaton GW, Williams WH, Mahoney EM, et al. 2005. Pulmonary outcomes of off-pump vs on-pump coronary artery bypass surgery in a randomized trial. Chest 127:892-901.n



How to Cite

Fukui, T., Manabe, S., Shimokawa, T., & Takanashi, S. (2009). Incidence and Outcomes of Pneumonia after Isolated Off-Pump Coronary Artery Bypass Grafting. The Heart Surgery Forum, 12(4), E194-E198.