Is Performing Off-Pump Coronary Artery Bypass More Stressful for the Surgical Team than Conventional Coronary Artery Bypass

Abstract

Objective: Though off-pump coronary artery bypass (OPCAB) is getting more popular today, some cardiac surgeons assume that it's too technically demanding and mentally stressful to perform it. In order to find out if OPCAB is more stressful than conventional coronary artery bypass (CCAB) for the surgical team, we conducted this study. Materials and Methods: This was a prospective non-randomized study, and was conducted in a rural community hospital from April to September 2005. We used ambulatory ECG monitoring to record the surgeon's and the perfusionist's heart rate during coronary artery bypass operations. Each procedure corresponding to the change of the heart rate was recorded simultaneously for later analysis. The increase of heart rate while performing a specific procedure was considered an elevation of the mental stress. Heart rate data and patient data from 14 operations were collected and analyzed. Results: Fourteen patients undergoing elective coronary bypass surgery were enrolled. All patients were assigned to either OPCAB or CCAB according to the surgeon's clinical judgment. Eight patients were assigned to OPCAB, and 6 to CCAB. No patient was converted to the other procedures. The surgeon's heart rate was intrinsically higher than the perfusionist's, reflecting mainly the interpersonal difference. The heart rates of both the surgeon and the perfusionist were slightly higher than average while performing the coronary anastomoses. No difference of heart rate of either the surgeon or the perfusionist could be observed, no matter whether they were performing the anterior, the lateral, or the inferior anastomoses between these two groups (OPCAB and CCAB) or during the whole procedure. These results imply that both the surgeon and the perfusionist experienced the same level of mental stress either performing CCAB or OPCAB. Conclusions: Performing OPCAB is not more stressful for the surgical team than CCAB. Careful patient selection, as well as appropriate training and familiarity with the procedures for the surgical team are advised.