Off-pump coronary surgery in selected patients: better early outcome but more recurrence of angina?
This non-randomized retrospective study included all patients operated on for CABG through median sternotomy between January 2000 and December 2002 by the same surgeon trained to both techniques. Using risk-adjusted comparison where expected mortality was given by the EuroSCORE value assessed pre-operatively, and studying mid-term survival and functional results we aimed to evaluate our indications for OPCAB versus conventional CABG through a consecutive series of 308 patients. Selected indications for OPCAB (n=154) were isolated LAD coronary system lesions and multivessel diseases with suitable anatomy in high surgical risk patients (EuroSCORE > or = 5). The first 154 patients operated on conventionally during the time-study interval were included in the control group. Expected mortality was significantly higher in the OPCAB group: 4.29 [95% CI: 3.83-4.77] vs. 3.54 [95% CI: 3.17-3.91] (P=0.024). Observed mortality was 1.3% and 2.6% for patients treated OPCAB and with conventional technique, respectively. Survival at three years was 91.5 and 93.8% in the conventional and OPCAB groups, respectively. Angina-free survival at three years was 95.8% and 89.6% in the conventional and OPCAB groups, respectively (P=0.04). To promote OPCAB in selected patients results in decreasing operative risk to the price of worsening late functional results.
Cardiac Surgery Department, Timone University Hospital, Marseilles, France. tcaus@ap-hm.fr
Thierry
T
Caus
Yves
Y
Serée
Pablo
P
Marin
Mahmoud
M
Khairi
Abdoul
A
Bakkali
Jean Claude
JC
Guillen
Jean Louis
JL
Bonnet
Dominique
D
Métras