A prospective observational study to compare conventional coronary artery bypass grafting surgery with off-pump coronary artery bypass grafting on basis of EuroSCORE.
BACKGROUND
The use of cardiopulmonary bypass during coronary artery bypass grafting (CABG) surgery has been associated with substantial morbidity. Off-pump coronary bypass (OPCAB) surgery has become a widely used technique during recent years. EuroSCORE risk scale is the most rigorously evaluated scoring system in cardiac surgery to preoperatively quantify the risk of death and other serious postoperative complications. The aim of this prospective observational study was to compare the mortality and morbidity between OPCAB and conventional CABG in three major preoperative groups as assessed by EuroSCORE.


METHODS
All consecutive patients undergoing isolated coronary artery bypass surgery between January 2003 and December 2004 at Wellington Hospital were included. In this period, 347 patients had conventional CABG and 254 patients had OPCAB. Data were prospectively collected according to Australasian Society of Cardiothoracic Surgeons' cardiac surgery data set. The preoperative additive EuroSCORE was computed in each patient and the patients were divided into three risk groups. Results of OPCAB and conventional CABG were compared on basis of EuroSCORE group.


RESULTS
OPCAB surgery is preferably performed in patients with low-risk. OPCAB group had lesser number of grafts per patient. When adjusted with risk score, there was no statistically significant difference in mortality in any of the three groups. No significant difference was found for stroke, renal dysfunction, atrial fibrillation, re-exploration for bleeding, deep sternal wound infection, or pulmonary complications in either of three groups. However, inotropic requirement and requirements of blood products were less in OPCAB group.


CONCLUSIONS
OPCAB does not offer any significant advantage in terms of mortality and morbidity over conventional CABG.
Singhal
Pawan
P
Department of Cardiothoracic Surgery, Waikato Hospital, Hamilton, New Zealand. singhal_pk@hotmail.com
Mahon
Barry
B
Riordan
John
J
D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods / Q000401:mortality; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome