title: Off-pump coronary surgery: effect on early mortality and stroke.
abstract: 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.
authors.affiliation: Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 6215, Los Angeles, CA 90048, USA. chengw@cshs.org
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Denton
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Fontana
authors.forename: Sharo
authors.initials: S
authors.lastname: Raissi
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanche
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kass
authors.forename: Kathy E
authors.initials: KE
authors.lastname: Magliato
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Alfredo
authors.initials: A
authors.lastname: Trento
mesh_terms: 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