Does multivessel, off-pump coronary artery bypass reduce postoperative morbidity?
BACKGROUND
Off-pump coronary artery bypass (OPCAB) is an emerging procedure. It is assumed that elimination of cardiopulmonary bypass for coronary artery bypass grafting has the potential for reducing postoperative morbidity. This review evaluates the safety and impact of multivessel OPCABG as compared to CABG.


METHODS
A retrospective review of 744 patients undergoing multivessel coronary artery bypass between January 1, 1997, and March 31, 1999, was done. The total population was divided into two groups: group A (n = 609 cardiopulmonary bypass) and group B (n = 135 OPCAB). This consecutive study cohort was elective status, full sternotomy with three or more distal anastomoses performed at a single institution.


RESULTS
The mean risk adjusted predicted mortality was 2.3% in group A and 2.7% in group B (p = NS), with the mean number of distal anastomosis being greater in group A (3.8 vs 3.5/patient, p < 0.001). Major postoperative complications were similar but were not statistically significant between groups. Postoperative blood loss and use of blood transfusions were the only significant variables (p < 0.001).


CONCLUSIONS
Multivessel OPCABG can be safely performed in selected patients. Elimination of cardiopulmonary bypass did not significantly reduce postoperative morbidity. Prospective randomized trials and long-term follow-up are needed to better define patient selection and the role of OPCABG.
Kshettry
V R
VR
Cardiac Surgical Associates, P.A., Minneapolis Heart Institute, Minnesota, USA.
Flavin
T F
TF
Emery
R W
RW
Nicoloff
D M
DM
Arom
K V
KV
Petersen
R J
RJ
D000368:Aged; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D015996:Survival Rate