The off-pump technique in redo coronary artery bypass grafting reduces mortality and major morbidities: propensity score analysis of data from the Japan Cardiovascular Surgery Database

Abstract

The off-pump technique reduced early operative mortality and the incidences of major complications in redo CABG.

Early health outcome and 10-year survival in patients undergoing redo coronary surgery with or without cardiopulmonary bypass: a propensity score-matched analysis

“…Only few studies have reported on the use of OPCAB technique for redo coronary surgery [ 1 , 6 , 16–19 ]. The largest report in 617 patients from Japan focuses on in-hospital outcome only with no late survival and suggests that redo-OPCAB surgery is associated with lower 30 days mortality (3.5 vs 7%) and less complications (11 vs 21.5%) compared to redo-CABG [ 1 ]. Other studies from North America and India have reported on redo-OPCAB, although in small cohorts [ 1 , 7 , 17 , 18 , 20 , 21 ].…”

“…Redo cardiac surgery represents 5–8% of the current surgical practice [ 1–4 ]. In particular, reoperative coronary artery bypass grafting (redo-CABG) remains challenging [ 1–4 ] with prolonged operation time, bleeding, poor access to coronary targets and risk of coronary microembolization leading to complications [ 2 , 3 ].…”

“…Redo cardiac surgery represents 5–8% of the current surgical practice [ 1–4 ]. In particular, reoperative coronary artery bypass grafting (redo-CABG) remains challenging [ 1–4 ] with prolonged operation time, bleeding, poor access to coronary targets and risk of coronary microembolization leading to complications [ 2 , 3 ]. Redo-CABG has declined over the last decade to 2.5–4% of all coronary procedures, probably due to improved platelet inhibition [ 2 , 3 ], use of more arterial conduits or to the use of percutaneous coronary intervention stenting to treat occluded grafts or new stenosis [ 5 ].…”

“…Poor risk profile in these patients may trigger complications associated with prolonged cardiopulmonary bypass and cardioplegic arrest time [ 6 ]. Studies from North America, Japan and India have highlighted the use of off-pump CABG as an alternative to redo coronary surgery (redo-OPCAB) [ 1 , 6 , 7 ]. However, most of these studies are based on small patient cohorts, and none of these studies has evaluated the impact of redo-OPCAB on long-term survival.…”

On- or Off-Pump Coronary Artery Bypass: What Is the Evidence?

“…Patients with high-risk of stroke, renal failure and redo-surgery may benefit from OPCAB surgery due to the minimal aorta manipulation and bypass of the systemic inflammatory process triggered by CPB (59,60).…”