title: Off-pump versus on-pump coronary artery bypass surgery in high-risk patients (EuroSCORE >/= 6).
abstract: OBJECTIVE
  The aim of this study was to review the results of off-pump (OPCAB) versus conventional on-pump coronary artery bypass surgery (CCAB) in high-risk patients.
  
  
  METHODS
  In a cohort of patients with an additive EuroSCORE >/= 6, 67 underwent OPCAB and 112 underwent CCAB.
  
  
  RESULTS
  Thirty-day postoperative death and stroke rates were 7.5 % and 6.0 % for the OPCAB group, and 5.4 % ( P = 0.75) and 8.0 % ( P = 0.77) for the CCAB group, respectively. No significant differences were observed for other major outcome endpoints other than cardiac troponin I (OPCAB: 117 +/- 428 ng/ml vs. CCAB: 58 +/- 99 ng/ml, P = 0.028), a result which was probably due to preoperative massive myocardial infarction in two very high-risk patients who underwent OPCAB. A similar outcome was also observed among propensity score-matched pairs. Congestive heart failure ( P = 0.006, OR: 6.366, 95 % CI: 1.682 - 24.093) and baseline cardiac index ( P = 0.018, OR: 0.171, 95 % CI: 0.040 - 0.735) were independent predictors of 30-day postoperative mortality.
  
  
  CONCLUSIONS
  OPCAB can be safely performed in high-risk patients with results as satisfactory as those achieved with CCAB.
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Lahtinen
authors.forename: F
authors.initials: F
authors.lastname: Biancari
authors.forename: J
authors.initials: J
authors.lastname: Rimpiläinen
authors.forename: R
authors.initials: R
authors.lastname: Kytökorpi
authors.forename: M
authors.initials: M
authors.lastname: Mosorin
authors.forename: P
authors.initials: P
authors.lastname: Rainio
authors.forename: R
authors.initials: R
authors.lastname: Cresti
authors.forename: T
authors.initials: T
authors.lastname: Juvonen
authors.forename: M
authors.initials: M
authors.lastname: Lepojärvi
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D017202:Myocardial Ischemia / Q000401:mortality / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome