Off-pump coronary artery bypass grafting decreases morbidity and mortality in a selected group of high-risk patients.
BACKGROUND
The ideal indication for off-pump coronary artery bypass grafting (OPCABG) has yet to be defined. High-risk surgical patients may benefit the most when cardiopulmonary bypass (CPB), aortic cross clamping, and cardioplegic arrest are avoided. The aim of this study was to determine whether off-pump coronary artery bypass grafting might decrease the operative morbidity and mortality in a select group of high-risk patients with multivessel coronary artery disease.


METHODS
Utilizing a Parsonnet risk stratification model we analyzed prospectively collected data on a cohort of high-risk coronary artery disease patients, which were operated on with beating-heart technology by the same group of surgeons in a tertiary care university medical center. High-risk patients were defined as those with a Parsonnet score of 15 or greater.


RESULTS
Fifty-seven multivessel disease OPCABG patients (over a period of 2 years) had markedly increased Parsonnet scores (24.3 +/- 10.6). The average ejection fraction of the patients was 42% (+/-12.3) and their age ranged from 52 to 85 years (mean 70.6 +/- 10.4, 26% women). Unstable angina was present in 42 patients (74%) and 10 patients underwent OPCABG within 24 hours of the occurrence of acute myocardial infarction. In addition to severe coronary artery disease 32% of the patients presented with congestive heart failure, insulin-dependent diabetes (18%), renal failure (22%), peripheral vascular disease (31%), pulmonary disease (18%), and neurologic disorders (14%). An average of 2.6 +/- 0.9 grafts/patient were performed and the posterior descending artery or marginal branches of the circumflex artery or both were grafted in 90%. The 30-day mortality rate was 3.5% (n = 2).


CONCLUSIONS
OPCABG can be performed with a reasonable low morbidity and mortality in this select group of high-risk patients. OPCABG is a reasonable, and might even be preferable, operative strategy in this high-risk group of patients.
Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis 55455, USA. bittn006@tc.umn.edu
Hartmuth B
HB
Bittner
Michael A
MA
Savitt
D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D018579:Patient Selection; D016896:Treatment Outcome