Changing referral pattern in off-pump coronary artery bypass surgery: a strategy for improving surgical results.
BACKGROUND
We have previously shown that a less invasive surgical approach (LISA) can reduce mortality and morbidity in coronary artery bypass grafting (CABG). This appears to have led to the referral of increasingly high risk patients for this procedure as compared to patients undergoing traditional CABG. The purpose of this paper is to compare preoperative risk factors and postoperative complications in both LISA and conventional CABG cases using the New York State database.


METHODS
From January 1997 to September 1998, 1,993 patients underwent CABG in our institution: 1,384 with CPB (group A) and 609 without CPB (group B). In group B (LISA), a well defined strategy was followed in an effort to prevent hemodynamic instability during coronary exposure, avoid myocardial ischemia, verify graft patency, and use alternative surgical incisions in reoperations.


RESULTS
Analysis of preoperative risk factors using the NYS database showed a significant increase in comorbidities in group B (p < 0.005), while at the same time postoperative complications and risk-adjusted mortality were lower (p = NS).


CONCLUSIONS
Our data demonstrates that by using the LISA, high risk patients can undergo CABG with equal or lower mortality and morbidity than traditional CABG.
Center for Minimally Invasive Cardiac Surgery, The Buffalo General Hospital at Kaleida Health, NY 14203, USA.
G
G
D'Ancona
H L
HL
Karamanoukian
P
P
Soltoski
T A
TA
Salerno
J
J
Bergsland
D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D009518:New York; D018579:Patient Selection; D011183:Postoperative Complications; D012017:Referral and Consultation; D012042:Registries; D012307:Risk Factors