Abstract
SummaryObjectiveOur aim was to compare short-term outcomes and long-term major adverse cardiovascular event (MACE)-free survival and independent predictors of long-term MACE after off-pump (OPCAB) versus on-pump beating-heart (ONBHCAB) coronary artery bypass grafting (CABG).MethodsWe retrospectively reviewed data of all consecutive patients who underwent elective CABG, performed by the same surgeon, from January 2003 to October 2009. A propensity score analysis was carried out to adjust for baseline characteristics and a total of 398 patients were included: ONBHCAB (n = 181), OPCAB (n = 217).ResultsOPCAB was associated with significantly shorter ventilation times (p < 0.001), intensive care unit stay (p < 0.001) and hospital stay (p < 0.001). The total blood loss was significantly more in the ONBHCAB group (p < 0.001), and accordingly, the number of transfused blood units was significantly lower in the OPCAB group (p < 0.001). Incidence of peri-operative renal complications were significantly higher in the ONBHCAB group (p = 0.004). The OPCAB group showed significantly lower long-term MACE-free survival (p = 0.029). The mean number of transfused blood units was the only independent predictor of MACE (HR: 1.218, 95% CI: 1.089–1.361; p = 0.001).ConclusionOPCAB provided better long-term MACE-free survival compared with ONBHCAB. Fewer units of blood transfused following OPCAB surgery may have been the main reason for this result.
Highlights
The total blood loss was significantly more in the on-pump beating-heart coronary artery bypass grafting (ONBHCAB) group (p < 0.001), and the number of transfused blood units was significantly lower in the off-pump coronary artery bypass surgery (OPCAB) group (p < 0.001)
Exclusion criteria were as follows: critical pre-operative state [need for inotropic drug support or intra-aortic balloon pumping (IABP), acute renal failure, requiring respiratory support, history of cardiopulmonary resuscitation in the pre-operative period], myocardial infarction (MI) within three weeks [cardiac troponin I > 0.01 ng/ml], patients who underwent single-vessel coronary artery bypass grafting (CABG), and cases that were converted from OPCAB to ONBHCAB (12 of 339 cases, 3.5%) or ONBHCAB to conventional CABG [10 of 443 cases (2.2%)] intra-operatively
The mean number of transfused red blood cells (RBC) units was significantly lower in the OPCAB group (p < 0.001)
Summary
The research was conducted according to the principles of the Declaration of Helsinki, and ethical approval was granted by the local research ethics committee In this retrospective study, we reviewed data for all patients who underwent isolated firsttime elective coronary bypass surgery at Uludag University Faculty of Medicine Hospital and Bursa Medical Park Hospital between January 2003 and October 2009. Exclusion criteria were as follows: critical pre-operative state [need for inotropic drug support or intra-aortic balloon pumping (IABP), acute renal failure, requiring respiratory support, history of cardiopulmonary resuscitation in the pre-operative period], myocardial infarction (MI) within three weeks [cardiac troponin I (cTnI) > 0.01 ng/ml], patients who underwent single-vessel CABG, and cases that were converted from OPCAB to ONBHCAB (12 of 339 cases, 3.5%) or ONBHCAB to conventional CABG [10 of 443 cases (2.2%)] intra-operatively. Re-operation was defined as re-operation due to bleeding or cardiac tamponade and graft failure
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