title: Multivessel off-pump coronary artery bypass: analysis of 4953 cases.
abstract: BACKGROUND
  To avoid the harmful effects of cardiopulmonary bypass (CPB), cardiac surgeons are using off-pump coronary artery bypass (OPCAB) as an effective alternative to conventional coronary artery bypass grafting (CABG). In the present study, we analyze our results with OPCAB in patients with multivessel coronary artery disease and compare them with those achieved in patients who underwent operations on CPB.
  
  
  METHODS
  Between January 1997 and April 2002, 4953 patients underwent CABG without CPB (OPCAB group). These patients were compared with 7133 patients who underwent conventional on-pump CABG (CCAB group) during the same period. All patients were operated on through a median sternotomy. The Octopus was used as the mechanical stabilizer, and intracoronary shunts were used in most patients. Transesophageal echocardiography was used in all patients, and epiaortic scanning was used in selected patients.
  
  
  RESULTS
  The mean patient age was 59 +/- 8.9 years in the OPCAB group and 57.4 +/- 8.9 years in the CCAB group (P <.001). There were more women in the OPCAB group (11.7% versus 10.4%; P =.023), and 2.8% of the patients required conversion to CPB. The mean numbers of grafts were 3.0 +/- 0.7 and 3.2 +/- 0.8 in the OPCAB and the CCAB groups, respectively (P <.001). More patients in the CCAB group received grafts to the circumflex territory. Intubation times (19 +/- 4 hours versus 25 +/- 6 hours; P <.001), blood losses (350 +/- 41 mL versus 598 +/- 74 mL; P <.001), requirements for blood and blood products (30.8% versus 45.3%; P <.001), the frequency of reopening for bleeding (0.6% versus 2.8%; P <.001), requirements for postoperative intra-aortic balloon pump (1.3% versus 2.6%; P <.001), the frequency of atrial fibrillation OPCAB group. The mortality rate was 0.97% and 1.86% in the OPCAB and the CCAB groups, respectively (P <.001). Intensive care unit stays (23 +/- 6 hours versus 34 +/- 8 hours; P <.001) and hospital stays (5 +/- 2 days versus 8 +/- 3 days; P <.001) were significantly shorter in the OPCAB group.
  
  
  CONCLUSIONS
  OPCAB is a safe and effective procedure for patients with multivessel coronary artery disease and is associated with reduced morbidity and mortality. However, large randomized studies with long-term follow-up may show the real benefits of OPCAB compared with CABG on CPB.
authors.affiliation: Department of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, New Delhi, India. meharwal@hotmail.com
authors.forename: Zile Singh
authors.initials: ZS
authors.lastname: Meharwal
authors.forename: Yugal Kishore
authors.initials: YK
authors.lastname: Mishra
authors.forename: Vijay
authors.initials: V
authors.lastname: Kohli
authors.forename: Sandeep
authors.initials: S
authors.lastname: Singh
authors.forename: Ramesh Kumar
authors.initials: RK
authors.lastname: Bapna
authors.forename: Yatin
authors.initials: Y
authors.lastname: Mehta
authors.forename: Naresh
authors.initials: N
authors.lastname: Trehan
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies