High risk coronary artery bypass patient: incidence, surgical strategies, and results.
BACKGROUND
To describe our experience in the treatment of high risk coronary artery bypass patients and compare patients assigned to on-pump or off-pump surgery.


METHODS
During a 42-month period 306 high risk (Euroscore > 5) coronary artery bypass patients were consecutively treated at our institution. On the basis of the coronary anatomy and possibility of achieving a complete revascularization, 197 patients were assigned to off-pump and 109 to on-pump operation. Overall mortality was 6.2% (19 of 306 patients).


RESULTS
Although patients treated off-pump had a better cardiac status, no clinical advantages related to the avoidance of cardiopulmonary bypass were found in the overall population. Off-pump patients had more early and late cardiac complications, whereas patients operated on-pump exhibited an higher incidence of postoperative systemic organ dysfunction. Off-pump surgery improved in-hospital outcome only in the subset of patients at highest risk.


CONCLUSIONS
Avoidance of cardiopulmonary bypass does not confer significant clinical advantages in all high risk coronary patients; instead, there are particular subsets of patients in whom beating heart surgery can be particularly indicated and others for whom on-pump revascularization appears a better solution. Adaptation of the operation to the single patient is probably the way to improve outcome.
Gaudino
Mario
M
Department of Cardiac Surgery, Catholic University, Rome, Italy. mgaudino@dtiscali.it
Glieca
Franco
F
Alessandrini
Francesco
F
Nasso
Giuseppe
G
Pragliola
Claudio
C
Luciani
Nicola
N
Morelli
Mauro
M
Possati
Gianfederico
G
D000368:Aged; D002315:Cardiopulmonary Bypass; D015897:Comorbidity; D023921:Coronary Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D012306:Risk; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000601:surgery