title: Coronary artery bypass grafting with cardiopulmonary bypass versus off-pump cardiopulmonary bypass grafting: does eliminating the pump reduce morbidity and cost?
abstract: BACKGROUND
  Cardiopulmonary bypass (CPB) may contribute to the complications and cost of coronary artery bypass grafting (CABG). Off-pump CABG (OPCAB) allows coronary revascularization without CPB. We hypothesized that OPCAB provides satisfactory graft patency while reducing complications and cost compared with CABG with CPB.
  
  
  METHODS
  We prospectively followed 80 patients undergoing CABG: 40 patients undergoing OPCAB and 40 patients undergoing CABG with CPB. OPCAB patients underwent angiography within 48 hours of surgery to determine early graft patency. Incidence of complications, length of stay, and costs were recorded for each patient. The influence of the number of vessels bypassed was analyzed.
  
  
  RESULTS
  OPCAB patients (n = 40) underwent grafting of 2.7 +/- 0.7 vessels per patient compared with 3.6 +/- 0.8 vessels per patient in the CABG with CPB group (n = 40) (p < 0.0001). Angiography demonstrated 105 of 108 (97%) of grafts were patent in the OPCAB group. Incidence of complications, length of stay, and costs did not differ between the OPCAB and CABG with CPB groups. Number of vessels grafted showed a positive correlation to total costs in both groups.
  
  
  CONCLUSIONS
  While OPCAB provided satisfactory early graft patency, there was no significant difference between OPCAB and CABG with CPB with regard to cost, length of stay, or incidence of complications. In this study, eliminating CPB did not reduce morbidity or cost after CABG.
authors.affiliation: Department of Surgery, University of Utah Health Sciences Center, Salt Lake City 84132, USA. david.bull@hsc.utah.edu
authors.forename: D A
authors.initials: DA
authors.lastname: Bull
authors.forename: L A
authors.initials: LA
authors.lastname: Neumayer
authors.forename: J C
authors.initials: JC
authors.lastname: Stringham
authors.forename: P
authors.initials: P
authors.lastname: Meldrum
authors.forename: D G
authors.initials: DG
authors.lastname: Affleck
authors.forename: S V
authors.initials: SV
authors.lastname: Karwande
mesh_terms: D002315:Cardiopulmonary Bypass / Q000191:economics; D001026:Coronary Artery Bypass / Q000191:economics / Q000379:methods*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D016896:Treatment Outcome; D014589:Utah; D014654:Vascular Patency