title: Off-pump coronary artery bypass is a safe option in patients presenting as emergency.
abstract: BACKGROUND
  The applicability of off-pump coronary-artery bypass (OPCAB) in patients who present as emergency remains controversial. Herein, we explore the efficacy and safety of OPCAB in patients who were indicated for emergency surgery.
  
  
  METHODS
  Between 2002 and 2007, a total of 282 patients underwent OPCAB, of which 68 were presented as emergency. This cohort (group A) was compared to 68 patients who had traditional on-pump coronary artery bypass grafting (CABG, group B) under emergency indications during the same period of time. Baseline demographics, intraoperative data and postoperative outcomes were analysed.
  
  
  RESULTS
  Preoperative demographics were comparable in both groups. Mortality during the first 30 days was comparable in both groups and no stroke occurred in the whole series. Patients in group A had significantly less pulmonary complications (4.4% vs 14.7%, P = 0.04), less ventilation time (30.3 ± 33.6 hours vs 41.5 ± 55.4 hours, P = 0.18) and were less likely to have prolonged ventilation, (19.1% vs 35.3%, P = 0.03). Similarly, OPCAB patients had less postoperative renal-failure/dysfunction (5.9% vs 8.8%, P = 0.51) and required less inotropic support (66.2% vs 88.2%, P = 0.002), bloodtransfusions (23% vs 86.8%, P <0.0001), and atrial- (17.6% vs 35.3%, P = 0.02) or ventricular-pacing (17.6% vs 41.2%, P = 0.002). Although the number of diseased vessels was comparable in both groups, patients in group A received less distal anastomoses. (2.78 ± 1.19 vs 3.41 ± 0.89, P = 0.002). Similarly, complete revascularisation was achieved less frequently in group A (76.5% vs 94.1%, P = 0.004).
  
  
  CONCLUSIONS
  OPCAB strategy is a safe and efficient in emergency patients with reasonable good short-term postoperative outcomes.
authors.affiliation: Department of Surgery, National University of Singapore, Singapore, Singapore.
authors.forename: Eliana C
authors.initials: EC
authors.lastname: Martinez
authors.forename: Maximilian Y
authors.initials: MY
authors.lastname: Emmert
authors.forename: George N
authors.initials: GN
authors.lastname: Thomas
authors.forename: Lorenz S
authors.initials: LS
authors.lastname: Emmert
authors.forename: Chuen Neng
authors.initials: CN
authors.lastname: Lee
authors.forename: Theo
authors.initials: T
authors.lastname: Kofidis
mesh_terms: D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012449:Safety; D012846:Singapore; D013223:Statistics as Topic; D013997:Time Factors