title: Perioperative advantages of off-pump coronary artery bypass grafting.
abstract: For the first time in Japan, off-pump coronary artery bypass grafting (OPCAB) was compared with the conventional on-pump technique, retrospectively examining the morbidity associated with coronary artery bypass grafting (CABG) and assessing the efficacy of OPCAB. In 2000, 158 patients underwent CABG: 95 patients (60%) had OPCAB (Group I) and 63 patients (40%) had conventional CABG (Group II). The operating time, length of intensive care unit (ICU) stay, ventilation time, postoperative bleeding, transfusion, postoperative renal function, occurrence of stroke, and early graft patency were examined in both groups. There were no hospital deaths in either group. The operating time, ICU stay, and ventilation time were significantly (p < 0.0001, p = 0.013, and p < 0.0001, respectively) shorter in Group I (351 +/- 85 min, 3.0 +/- 1.4 days, and 5.1 +/- 2.8h) than in Group II (449 +/- 112 min, 3.6 +/- 1.8 days, and 13.7 +/- 18.0 h). The postoperative blood loss within 12h and the transfusion volume were significantly (p = 0.0004 and p < 0.0001, respectively) smaller in Group I (480 +/- 210 ml and 300 +/- 490ml) than in Group II (720 +/- 430ml and 1,230 +/- 1,180 ml). Peak serum blood urea nitrogen and creatinine concentrations (excluding patients with preoperative chronic renal failure, ie a preoperative serum creatinine > 1.5 mg/dl) were significantly (p < 0.0001 and p < 0.0001, respectively) lower in Group I (16.2 +/- 15.2mg/dl and 0.81 +/- 0.72 mg/dl) than in Group II (19.2 +/- 7.6 mg/dl and 0.92 +/- 0.28 mg/dl). There were no perioperative strokes in Group I, but 6.4% of Group II patients suffered a stroke. There was no significant difference in graft patency between the groups (95.6% vs 94.9%). OPCAB reduced the mortality and morbidity of coronary revascularization, with a shorter operating time and more rapid recovery from surgery.
authors.affiliation: Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Ishida
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Osamu
authors.initials: O
authors.lastname: Tagusari
authors.forename: Ko
authors.initials: K
authors.lastname: Bando
authors.forename: Kazuo
authors.initials: K
authors.lastname: Niwaya
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakajima
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology*; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006355:Heart-Lung Machine; D006801:Humans; D007362:Intensive Care Units; D007431:Intraoperative Complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors