Off-Pump CABG for Mulitvessel Coronary Artery Disease-Safe Incorporation into Surgical Practice

Abstract

Introduction:Since its revival two decades ago development of the surgical technique, along with evidence and clinical outcomes of off-pump coronary artery bypass surgery (OPCAB) were brought into focus. Methods: We report a single surgeon, single center experience of the first 37 consecutive patients undergoing off-pump surgery. Patients were selected for OPCAB (study group) individually and matched retrospectively to a control group of 113 patients performed over an identical time frame. Data were retrieved from a hospital data base (TOMCAT). Results: Mean Logistic European System of Cardiac Operative Risk Stratification (EuroSCORE) was slightly higher in the off-pump group (3.8% versus 2.9%). One patient died during the study and this was in the off-pump CAB group (OPCAB-30 day mortality 2.7%). Operating time was slightly shorter in the off-pump group (3 hours 28 minutes versus 3 hours 49 minutes, p = 0.15). After exclusion of outliers, total hospital stay was significantly shorter for off-pump cases (mean 6.8 days versus 8.37 days), while Intensive Care Unit (ICU) stay (1.2 versus 1.4 days) and ventilation time were only slightly shorter (9.35 hours versus 10.6 hours) for off-pump cases. Chest tube drainage was significantly lower in the off-pump group (484 ml versus 744 ml, p = 0.04) with correspondingly slightly lower transfusion requirements and significantly increased discharge haemoglobin concentrations in OPCAB. There was one cerebrovascular accident (CVA) in the off-pump group and none in the on-pump group. Conclusion: In this study we show short term outcomes for introduction of off-pump into surgical technique. Length of ICU stay, ventilation times, chest tube drainage, transfusion requirements and pre-discharge haemoglobin concentration all appeared superior in the off pump group. The off-pump technique was safely introduced into the surgeon's service with relatively little mortality. Experience of surgeon was considered advantageous for fast adaption of the technique. However, numbers were too small to make strong inferences. With practice more patients should benefit from the technique. of refinements have been made in anaesthetic and surgical techniques, such as designs of pumps, oxygenators and cannulae, and advantage from avoiding ECC, reduced morbidity was not impressively apparent throughout the studies. Overall proportion of isolated off-pump CABG is currently 20.2% for the European countries [3] and about 25% in the US [4]. In Asian countries majority of CABG surgery is performed off-pump. There are European institutions that report particularly high percentages of off-pump CABG with dedicated training programs for surgical trainees [5,6]. Applying CABG may reduce costs, one of the reasons it lead to application in South Africa and revival of the technique in early 1990s. With low intraoperative conversion rate (≤8.5%) costs can be reduced [7]. Currently there is no guideline suggesting off-pump as technique of first choice in any