Total arterial off-pump versus on-pump coronary revascularization: comparison of early outcome.
OBJECTIVE
To assess differences in the early outcome after complete arterial myocardial revascularization with (ONCAB) or without cardiopulmonary bypass (OPCAB).


METHODS
Out of 870 consecutive CABG procedures 58 OPCAB and 91 ONCAB patients receiving exclusive arterial grafts were analyzed. OPCAB patients had more single-vessel (p < 0.0001), less triple-vessel (p < 0.0001) or left main disease (p = 0.0021), higher angina class (p = 0.003), unstable angina (p < 0.0001) or previous PTCAs (p < 0.0001).


RESULTS
ONCAB was associated with longer operations (182.5 +/- 38 vs. 147 +/- 56 min; p = 0.0001) and more anastomoses/patient (3.2 +/- 1 vs. 2 +/- 0.9; p < 0.0001), but incomplete revascularization was similar in both groups (11% vs. 17%; p = ns). ITA use was identical, whereas single left internal thoracic artery (LITA) use (25.9% vs.1%; p < 0.0001) and LITA jump anastomoses (10.3% vs. 7.7%; p < 0.0001) were more frequent in OPCAB. Radial artery (RA) use (89% vs. 46.6%; p < 0.0001) and RA jump anastomoses (57.1% vs. 12.1%; p < 0.0001) were more frequent in ONCAB. Mortality, arrhythmias, cerebro-vascular accidents (CVA), and renal failure were similar, but ventilatory support shorter (8.8 +/- 11.8 vs. 15.6 +/- 9.4 h; p < 0.0001) and cardiac enzyme release smaller (p < 0.0001) after OPCAB with a trend toward less myocardial infarction (1.7% vs. 7.7%; p = 0.12) and low output (1.7% vs. 8.8%; p = 0.089), and more respiratory complications (10.3% vs. 2.2%; p = 0.056).


CONCLUSIONS
Arterial OPCAB patients have less extensive CAD, but more severe symptoms. Early outcome is similar concerning mortality, arrhythmias, CVA, renal failure, or ICU and hospital stay, but with shorter ventilatory support and lower cardiac enzymes with a trend toward lower myocardial infarction and low output, but higher respiratory complication rates after OPCAB.
Berdat
Pascal A
PA
Clinic for Cardiovascular Surgery, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland. pascal.berdat@insel.ch
Müller
Karen
K
Schmidli
Jürg
J
Kipfer
Beat
B
Eckstein
Friedrich
F
Carrel
Thierry
T
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D015415:Biomarkers / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods; D023921:Coronary Stenosis / Q000378:metabolism / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery*; D003402:Creatine Kinase / Q000378:metabolism; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D003402:Creatine Kinase