title: Emergency coronary artery bypass grafting can be performed safely without cardiopulmonary bypass in selected patients.
abstract: BACKGROUND
  Patients requiring emergency surgical revascularization are often not considered for off-pump coronary artery bypass grafting (OPCAB).
  
  
  METHODS
  From 1996 to 2003, 614 patients underwent emergency coronary artery bypass grafting (Society of Thoracic Surgeons definition) at an academic institution. Forty-four (7%) of these procedures were performed without cardiopulmonary bypass, while 570 were conventional coronary artery bypass procedures with cardiopulmonary bypass (CABG/CPB). Data were collected prospectively into a computerized database and reviewed retrospectively.
  
  
  RESULTS
  Though a greater proportion of CABG/CPB patients had critical left main stenosis (15.9% vs 38.3%, p = 0.005), other preoperative risk factors were similar between groups. Completeness of revascularization (No. distal anastomoses/No. diseased vessel systems) was significantly greater in the CABG/CPB group (1.51 +/- 0.03 vs 1.25 +/- 0.07, p = 0.003). There were no differences among individual complication rates (death, cardiac reoperation, postoperative myocardial infarction, permanent cerebral vascular accident, deep sternal wound infection, renal failure requiring hemodialysis, and respiratory failure requiring reintubation). However, the combined incidence of these endpoints was significantly lower in the OPCAB group (6.8% vs 21.1%, p = 0.038). OPCAB patients received fewer blood transfusions (65.9% vs 84.9%, p = 0.004) and had a significantly shorter intensive care unit stay (1.47 vs 3.20 days, p = 0.016). In-hospital mortality (0% vs 6.3%, p = 0.168) and mean postoperative length of stay (5.48 vs 7.03 days, p = 0.414) favored OPCAB, but did not reach statistical significance.
  
  
  CONCLUSIONS
  Off-pump coronary artery bypass can be performed safely and effectively and should be considered in selected patients with acceptable hemodynamics undergoing emergency coronary revascularization.
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Faraz
authors.initials: F
authors.lastname: Kerendi
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Craver
authors.forename: William A
authors.initials: WA
authors.lastname: Cooper
authors.forename: Ellis L
authors.initials: EL
authors.lastname: Jones
authors.forename: Omar M
authors.initials: OM
authors.lastname: Lattouf
authors.forename: J David
authors.initials: JD
authors.lastname: Vega
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects; D004638:Emergency Treatment; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies