Off-pump coronary surgery: effect on early mortality and stroke.
BACKGROUND
Avoiding cardiopulmonary bypass in coronary artery bypass grafting is thought to reduce early mortality and morbidity.


METHODS
We used our prospective database to compare all patients having off-pump coronary surgery (n = 389) with those having on-pump coronary surgery (n = 2412) between March 15, 1995, and November 1, 2000. Patients were grouped by age (years) in decades (>90, 80-89, 70-79, 60-69, <60 years). The Northern New England risk model was applied. Thirty-two independent variables were entered into a stepwise logistic regression analysis with the end points being surgical mortality and postoperative stroke.


RESULTS
Patients undergoing off-pump operations were older (70.9 +/- 12 vs 68.1 +/- 11 years; P <.001), and their Northern New England predicted risk was higher (11.9% +/- 13% vs 9.2% +/- 10%; P <.001). However, patients having on-pump bypass had significantly more bypass grafts constructed (3.3 +/- 0.8 vs 1.9 +/- 0.8; P <.001) and triple-vessel coronary artery disease (58% vs 28%; P <.001). There were no significant differences in postoperative mortality, stroke rate, complications, and length of stay between the groups. Logistic regression analysis did not show that cardiopulmonary bypass was a risk factor for either surgical mortality (odds ratio, 1.08; P =.83) or stroke (odds ratio, 1.59; P =.27).


CONCLUSIONS
Off-pump coronary bypass did not reduce early mortality and morbidity. Early and late results should be compared in a prospective randomized study.
Cheng
Wen
W
Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 6215, Los Angeles, CA 90048, USA. chengw@cshs.org
Denton
Timothy A
TA
Fontana
Gregory P
GP
Raissi
Sharo
S
Blanche
Carlos
C
Kass
Robert M
RM
Magliato
Kathy E
KE
Mirocha
James
J
Trento
Alfredo
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D016019:Survival Analysis; D016896:Treatment Outcome