title: Off-pump versus on-pump coronary artery bypass grafting in acute coronary syndrome: a clinical analysis.
abstract: BACKGROUND
  Although off-pump coronary artery bypass (OPCAB) surgery has many beneficial effects compared with on-pump surgery, switch to on-pump surgery has significantly higher risks of operative mortality. Benefits of OPCAB over on-pump surgery strategies concerning myocardial revascularization are still debatable. We have aimed to develop an "algorithm of off-pump surgical strategy" on preventing conversion to on-pump. This clinical study reports our clinical outcome of OPCAB in patients with acute coronary syndrome.
  
  
  METHODS
  Between January 2006 and December 2008, 198 patients with acute coronary syndrome were enrolled in the study. Decision of OPCAB (142 patients) or on-pump surgery (56 patients) was made according to patients' present clinical status and our surgical background. Cardiac enzymes, duration of the surgery, graft numbers, stay in intensive care unit were recorded.
  
  
  RESULTS
  OPCAP group has shorter operation time (82.78 min versus 164.22 min, p < 0.001), lesser necessity for intra-aortic balloon pumping (3.5% versus 12.5%, p = 0.053), shorter duration of intensive care unit stay (p < 0.05) and hospital stay (p < 0.001) compared to on-pump patients. EuroSCORE level was lower in OPCAP group (p < 0.001). None of the patients of OPCAB group required conversion to on-pump technique.
  
  
  CONCLUSIONS
  The patients who admitted to the hospital with acute coronary syndrome within "golden hours" (within 6 hours after onset) had a greater chance for OPCAB surgery. This study proves that EuroSCORE is likely to be an important factor in deciding which surgical technique to use, but a further investigation is needed to verify. According to our findings, a careful evaluation of coronary angiography, hemodynamic status, quality of target coronary vessel and timing of surgery are important for OPCAB surgery to avoid conversion to on-pump. By a careful systematic evaluation of the patients as explained with this article, it can be prevent or reduce conversion to on-pump surgery during OPCAB surgery.
authors.affiliation: Division of Cardiovascular Surgery, Ozel Ulus Hastanesi, Ankara, Turkey. drkaankaya@yahoo.com
authors.forename: Kaan
authors.initials: K
authors.lastname: Kaya
authors.forename: Raif
authors.initials: R
authors.lastname: Cavolli
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Telli
authors.forename: Mehmet Fazil Tolga
authors.initials: MF
authors.lastname: Soyal
authors.forename: Alp
authors.initials: A
authors.lastname: Aslan
authors.forename: Gökhan
authors.initials: G
authors.lastname: Gokaslan
authors.forename: Sahin
authors.initials: S
authors.lastname: Mursel
authors.forename: Refik
authors.initials: R
authors.lastname: Tasoz
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D006801:Humans