title: Off-pump compared to minimal extracorporeal circulation surgery in coronary artery bypass grafting.
abstract: OBJECTIVE
  Coronary artery bypass grafting (CABG) using extracorporeal circulation (ECC) is still the gold standard. However, alternative techniques have been developed to avoid ECC and its potential adverse effects. These encompass minimal extracorporeal circulation (MECC) or off-pump coronary artery bypass grafting (OPCAB). However, the prevailing potential benefits when comparing MECC and OPCABG are not yet clearly established.
  
  
  METHODS
  In this retrospective study we investigated the potential benefits of MECC and OPCABG in 697 patients undergoing CABG. Of these, 555 patients had been operated with MECC and 142 off-pump. The primary endpoint was Troponin T level as an indicator for myocardial damage.
  
  
  RESULTS
  Study groups were not significantly different in general. However, patients undergoing OPCABG were significantly older (65.01 years ± 9.5 vs. 69.39 years ± 9.5; p value <0.001) with a higher Logistic EuroSCORE I (4.92% ± 6.5 vs. 5.88% ± 6.8; p value = 0.017). Operating off pump significantly reduced the need for intra-operative blood products (0.7% vs. 8.6%; p-value <0.001) and the length of stay in the intensive care unit (ICU) (2.04 days ± 2.63 vs. 2.76 days ± 2.79; p value <0.001). Regarding other blood values a significant difference could not be found in the adjusted calculations. The combined secondary endpoint, major cardiac or cerebrovascular events (MACCE), was equal in both groups as well.
  
  
  CONCLUSIONS
  Coronary artery bypass grafting using MECC or OPCABG are two comparable techniques with advantages for OPCABG regarding the reduced need for intra-operative blood products and shorter length of stay in the ICU. However serological values and combined endpoint MACCE did not differ significantly in both groups.
authors.affiliation: Department of Cardiac Surgery, University Hospital Basel, Switzerland; oreuthebuch@uhbs.ch.
authors.forename: Oliver
authors.initials: O
authors.lastname: Reuthebuch
authors.affiliation: Department of Cardiac Surgery, University Hospital Basel, Switzerland.
authors.forename: Luca
authors.initials: L
authors.lastname: Koechlin
authors.affiliation: Department of Cardiac Surgery, University Hospital Berne, Switzerland.
authors.forename: Brigitta
authors.initials: B
authors.lastname: Gahl
authors.affiliation: Department of Cardiac Surgery, University Hospital Basel, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Matt
authors.affiliation: Department of Cardiac Surgery, University Hospital Basel, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schurr
authors.affiliation: Department of Cardiac Surgery, University Hospital Basel, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Grapow
authors.affiliation: Department of Cardiac Surgery, University Hospital Basel, Switzerland.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Eckstein
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D052279:Creatine Kinase, MB Form / Q000097:blood; D003422:Critical Care; D005112:Extracorporeal Circulation / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology; D061646:Operative Time; D012086:Reoperation; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T; D052279:Creatine Kinase, MB Form