title: Myocardial revascularization of the beating heart in high-risk patients.
abstract: OBJECTIVE
  Myocardial revascularization without cardiopulmonary bypass (CPB) has been proposed as an alternative technique in patients at high risk for conventional coronary artery bypass grafting (CABG). The purpose of this article is to evaluate the potential benefit of such an approach.
  
  
  METHODS
  We retrospectively evaluated the perioperative results of off-pump CABG (OPCAB) performed from January 1995 to December 1999. Patients were divided into three groups on the basis of their preoperative risk factors: age greater than 80 years, reoperative CABG, and left ventricular ejection fraction percentage (LVEF%) less than 40%. The three subgroups were compared with patients operated on-CPB (ONCAB) during the same period of time. A total of 172 octogenarians had ONCAB versus 97 OPCAB, 307 reoperations were ONCAB versus 274 OPCAB, and 514 patients with LVEF% less than 40% were operated ONCAB versus 220 OPCAB.
  
  
  RESULTS
  Preoperative comorbidities were homogeneously distributed in the OPCAB and ONCAB groups. More extensive coronary artery disease was found in the ONCAB groups. A trend for a lower number of perioperative complications was reported in the OPCAB groups. Freedom from overall complications was significantly higher (p < 0.005) in the OPCAB group. Actual mortality rates in the OPCAB and ONCAB groups were comparable (p = NS).
  
  
  CONCLUSIONS
  CABG can be performed safely without CPB in patients with a high preoperative risk profile. Freedom from perioperative complications is markedly higher when the OPCAB approach is utilized.
authors.affiliation: State University of New York at Buffalo and Kaleida Health, Buffalo General Hospital, USA.
authors.forename: G
authors.initials: G
authors.lastname: D'Ancona
authors.forename: H
authors.initials: H
authors.lastname: Karamanoukian
authors.forename: A T
authors.initials: AT
authors.lastname: Kawaguchi
authors.forename: M
authors.initials: M
authors.lastname: Ricci
authors.forename: T A
authors.initials: TA
authors.lastname: Salerno
authors.forename: J
authors.initials: J
authors.lastname: Bergsland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000517:prevention & control*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume