Trend and early clinical outcomes of off-pump coronary artery bypass grafting in the UK

Abstract

OBJECTIVES The popularity of off pump coronary artery bypass grafting varies across the world, ranging from 20% in Europe and USA to 56% in Asia. We present the trend and early clinical outcomes in off pump in the United Kingdom. METHOD All patients who underwent elective or urgent isolated CABG from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. The trend in operating surgeons and units volume and training in off pump were analysed. Early clinical outcomes between off- and on pump Coronary Artery Bypass grafting were compared using propensity score matching. RESULTS A total 351422 patients were included. The overall off pump rate during the study period was 15.17%, it peaked in 2008 (19.8%), followed by a steady decreased to 2018 (7.63%). Its adoption varied across centres and surgeons, ranging from <1% to 48.36% and <1% to 85.5% respectively of total cases performed. After propensity score matching for the period 1996–2019, off pump, when compared to on pump, was associated with a lower in-hospital/30 day mortality (1.2% vs 1.5%, p < 0.001), return to theatre (3.7% vs 4.5%, p < 0.001), cerebrovascular accident (Transient Ischaemic Attack: 0.3% vs 0.6%, Stroke: 0.3% vs 0.6%, p < 0.001) and deep sternal wound infection (0.8% vs 1.2%, p = <0.001). In a sub analysis from the introduction of Euroscore II (2012–2019) there was no differences in-hospital/30 day mortality [1.0% vs 1.0%, p = 0.71]. However, on pump, had a higher return to theatre [4.2% vs 2.7%, p < 0.001], cerebrovascular accident [Transient Ischaemic Attack: 0.4% vs 0.2%, Stroke: 0.5% vs 0.3%, p = 0.003] and deep sternal wound infection [1.0% vs 0.6%, p = 0.004]. CONCLUSION Our data show a decreasing trend in the use of off pump in the UK since 2008. This is likely to be multifactorial and raises the question on whether it should be a specialized revascularisation technique.

Construction and validation of a risk prediction model for postoperative delirium in patients with off‐pump coronary artery bypass grafting

“…Along with the improvement of living standards among people, the incidence of coronary heart disease has increased year by year, as has the number of patients undergoing off-pump coronary artery bypass grafting (OPCABG) ( 1 , 2 ). Compared with on-pump coronary artery bypass grafting, OPCABG, a technique in which the anastomoses are performed on the beating heart, can reduce myocardial injury by preserving native coronary blood flow ( 3 , 4 ).…”