Clinical outcomes and resource usage in 100 consecutive patients after off-pump coronary bypass procedures

Abstract

Background. Cardiopulmonary bypass initiates a cascade of inflammatory processes that may result in end-organ damage, leading to the increased prevalence of noncardiac complications. Therefore, off-pump coronary artery bypass graft (OP-CAB) procedures have recently been introduced into clinical practice. Methods. This study was a case-controlled study that compared the outcomes and cost of 100 consecutive OP-CAB procedures with a control group of 100 contemporary matched conventional coronary artery bypass grafting procedures. All operations were performed by a single surgeon (J.H.L.) and complete revascularization that used off-pump techniques was achieved with the use of innovative exposure techniques to the lateral and posterior wall vessels. Results. An average of 3.1 grafts per patient were performed in the OP-CAB group (range, 1-5). The incidence of conversion to conventional coronary artery bypass grafting was 1%. The overall mortality rate was 2.0%. There were no instances of stroke, renal failure, or sternal infections in the OPCAB group. Thus, the OP-CAB group had a shorter length of stay (6.1 ± 2.5 versus 7.1 ± 3.3 d; P =.003), with a corresponding reduction in variable direct cost per case of 29% (P <.001). Conclusion. Our experience suggests that OP-CAB procedures are feasible for most patients who currently require complete revascularization. It is associated with very a low morbidity rate and may represent the ideal revascularization strategy for patients at high risk for undergoing cardiopulmonary bypass. (Surgery 2000;128:548-55.)