One-stage coronary and abdominal aortic operation with or without cardiopulmonary bypass: early and midterm follow-up.
BACKGROUND
The aim of this study was to compare hospital, early, and late clinical outcomes for patients undergoing one-stage, coronary and abdominal aortic surgical intervention with and without cardiopulmonary bypass.


METHODS
From March 1990 to September 1999, 42 consecutive patients underwent combined operations at a single institution. Cardiopulmonary bypass and cardioplegic arrest were used during coronary revascularization in the first 20 patients (on-pump group), and the next 22 patients received the one-stage operations on the beating heart (off-pump group).


RESULTS
Baseline characteristics were similar between groups. Three cardiac-related hospital deaths occurred in the on-pump group and one such death in the off-pump group (p = 0.25). Cardiac-related events, pulmonary complications, inotropic support, blood loss and transfusion requirements, intensive care unit stay, and hospital stay were significantly reduced in the off-pump group (all, p < 0.05). The actuarial survival rates in the on-pump and off-pump groups were 80% and 95%, respectively, at 1 year (p = 0.13) and 75% and 89%, respectively, at 3 years (p = 0.22). Freedom from cardiac-related events at 1-year follow-up was 91% in the off-pump group and 65% in the on-pump group (p < 0.05). No difference in cardiac-related events between groups was observed at 3 years.


CONCLUSIONS
Off-pump coronary surgical procedures decrease postoperative complications in high-risk patients undergoing simultaneous coronary and abdominal aortic operations compared with the conventional one-stage procedure. The early benefits achieved with off-pump surgical intervention are not at the expense of the long-term clinical outcome.
Ascione
R
R
Department of Cardiovascular Surgery, University Federico II of Naples, Italy. r.ascione@bristol.ac.uk
Iannelli
G
G
Lim
K H
KH
Imura
H
H
Spampinato
N
N
D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate