title: Improved short-term outcomes with off-pump reoperative coronary artery bypass grafting.
abstract: OBJECTIVE
  Reoperative coronary surgery patients are usually sicker and older, and the procedure is more technically demanding. Comparisons between coronary surgery with (coronary artery bypass [CAB] surgery on cardiopulmonary bypass [CPB]) and without (off-pump CAB [OPCAB]) the pump have been conducted; however, few studies showed results in reoperative cases. We investigate the potential superiority of one technique over the other in redo coronary surgeries.
  
  
  METHODS
  Our institutional Society of Thoracic Surgery database was used to gather the data for 266 isolated reoperative coronary artery surgeries from January 2004 to July 2011. These were divided into the CAB surgery in CPB group (n = 204) and the OPCAB group (n = 62).
  
  
  RESULTS
  Baseline characteristics of the two groups were similar, except for a significantly higher prevalence of cerebrovascular disease among the off-pump group (P = 0.01). There was also a trend toward fewer vessels bypassed among the same group (P = 0.07). Risk adjustment was done using multivariable analyses for detection of independent effects. The use of CPB was an independent predictor of increased rates of postoperative events (odds ratio, 3.9; P = 0.004) and atrial fibrillation (odds ratio, 5.9; P < 0.005) and longer intensive care unit (0.006) and hospital stay (0.004).
  
  
  CONCLUSIONS
  Redo OPCAB seems to offer favorable short-term outcomes compared with redo CAB. Our results suggest a reduced rate of overall postoperative events, decreased new postoperative atrial fibrillation, reduced hours stayed in the intensive care unit, and fewer days stayed from surgery to discharge. This was not associated with an increase in morbidity and mortality. A randomized study with a larger number of patients and with a longer follow-up is needed.
authors.affiliation: From the Houston Methodist DeBakey Heart & Vascular Center, Houston, TX USA.
authors.forename: Basel
authors.initials: B
authors.lastname: Ramlawi
authors.forename: Kareem
authors.initials: K
authors.lastname: Bedeir
authors.forename: Luis
authors.initials: L
authors.lastname: Garcia-Morales
authors.forename: Limael
authors.initials: L
authors.lastname: Rodriguez
authors.forename: Michael
authors.initials: M
authors.lastname: Reardon
authors.forename: Mahesh
authors.initials: M
authors.lastname: Ramchandani
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods* / Q000592:standards; D003324:Coronary Artery Disease / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology