Beating heart versus conventional coronary bypass surgery : Our experience

Abstract

Background: Off-pump Coronary Artery Bypass (OPCAB) has become the standard surgical treatment of Coronary Artery Disease in most centres in India. It is clear from the current evidence that, in certain patients, OPCAB offers advantages over conventional Coronary Artery Bypass Grafting (CABG). Experience of this procedure in the Armed Forces is highlighted. Methods: Retrospective analysis of 200 nonrandomized consecutive patients taken up for OPCAB and 200 conventional CABG between Jan 2005 and Dec 2007 was done. The European system for cardiac operative risk evaluation (euroSCORE) was used in all patients. Perioperative morbidity and mortality was compared in the two groups. Result: OPCAB was possible in 192 (96 %) out of 200 patients taken up for this procedure. Eight patients required cardiopulmonary bypass (CPB) to complete the revascularization. Incidence of reoperation for bleeding was 2.5% in OPCAB and 6% in CABG In the CABG group 2% patients developed severe bleeding complications, 3% required ventilation for more than 24 hour, 1% required renal replacement therapy, 1% had acute respiratory distress syndrome and 3.5% had neuro-psychiatric manifestations. Incidence of these complications in OPCAB patients was lower or NIL. Overall mortality in the OPCAB group was 1.5% and 2% in the CABG group. However only one patient out of 192 (0.5%) who underwent successful OPCAB died, while two patients out of eight who required conversion to CPB in this group died. Incidence of stroke, deep sternal infection and mortality was similar in both groups. Conclusion: OPCAB is safe, effective and can be offered to more than 90% patients as the primary strategy for surgical myocardial revascularization. It has lower overall morbidity than conventional CABG Its main limitations are hemodynamic instability and inability to find a deeply embedded target vessel. Both these factors affect the outcome adversely making conventional CABG a better option in these situations.