title: Outcomes for off-pump coronary artery bypass grafting in high-risk groups: a historical perspective.
abstract: BACKGROUND
  The outcomes of off-pump coronary artery bypass (OPCAB) and conventional coronary artery bypass grafting with cardiopulmonary bypass (cCABG) have been compared in detail. Similarly, several reports have examined outcomes of high-risk subsets of patients in OPCAB as a selection strategy for reducing morbidity and mortality compared to cCABG. We undertook a retrospective study comparing outcomes from the early years in our experience of beating-heart surgery in high-risk patients selected for OPCAB compared to low-risk patients having OPCAB. This study was premised on strict selection criteria in an era prior to stabilizing devices and cardiac positioners.
  
  
  METHODS
  A total of 384 patients underwent OPCAB over a 10-year period. Clinical outcomes were compared for 280 low-risk patients and 104 high-risk patients (redo CABG, CABG with simultaneous carotid endarterectomy, or renal insufficiency/failure).
  
  
  RESULTS
  The high-risk group patients were significantly older than the low-risk group patients (64.3 +/- 10.5 years versus 61.5 +/- 11.7 years, respectively, P = .048). The high-risk group also had a greater degree of left ventricular dysfunction (P < .001), a higher incidence of diabetes (P = .046), and a higher proportion of patients with peripheral vascular disease (P = .009). There was no significant difference in the number of grafts created, but there was a statistical difference in the type of graft used. The high-risk group received fewer internal thoracic artery grafts (P = .005) and more saphenous vein grafts (P = .041). The high-risk group had slightly prolonged median lengths of stay in the intensive care unit (2.2 versus 1.4 days, P < .001) and hospital (11 versus 8 days, P < .001) and a higher proportion of patients requiring blood transfusions (48% versus 24%, P < .001), yet there was no significant difference in major adverse outcomes.
  
  
  CONCLUSIONS
  In this retrospective and historical review, OPCAB was found to be equally safe in carefully selected high- and low-risk patients. These results provided for the enthusiasm and innovation to expand the usage of OPCAB in patients with coronary artery disease.
authors.affiliation: Department of Surgery, George Washington University and Veterans Affairs Medical Centers, USA.
authors.forename: Graham J
authors.initials: GJ
authors.lastname: Moore
authors.forename: Albert
authors.initials: A
authors.lastname: Pfister
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Trachiotis
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation; D016896:Treatment Outcome