Abstract
Coronary artery bypass grafting (CABG) remains the most frequent surgery in the practice of an adult cardiac surgeon and the most frequently performed cardiac surgical procedure worldwide. Despite the ongoing debates regarding the superiority or inferiority of off-pump coronary artery bypass grafting, it still comprises 15–30% of all CABG cases varying in different national registries. We performed a propensity matched study of 302 consecutive CABG patients,143 off -pump cases performed by the four experienced off-pump surgeons and the on-pump CABG cases performed by those surgeons and four other experienced coronary surgeons. The five year follow up was performed and data collected comprised of mortality, rehospitalization due to cardiac origin, repeated revascularization, myocardial infarction and cerebrovascular accident. Overall, the off-pump group of patients had a higher risk profile than the patients in the on-pump group. After matching, fewer differences were found between the groups. Propensity score matching analysis showed no difference in long-term survival as well as MACCE and repeated revascularization. The higher risk profile of the patients subjected to OPCAB and the comparable survival to lower risk CPB patients in this series indicate that in experienced hands, OPCAB is a valuable option in this important subgroup of patients.
Highlights
Despite the ongoing debates regarding the superiority or inferiority of OPCAB, it still comprises 15–30% of all Coronary artery bypass grafting (CABG) cases varying in different national registries
Patients in the OPCAB group had a higher proportion of diabetes mellitus and chronic kidney disease
Our results demonstrate that OPCAB surgery is not inferior to on-pump CABG surgery
Summary
We included 302 patients subjected to isolated CABG, either off- or on-pump during 2012–2013 performed by experienced surgeons in the department for cardiac surgery. The 143 off-pump cases were consecutive patients operated on by four surgeons with more than 250 previous OPCAB cases per surgeon. The control group comprised of 159 patients operated on-pump during the same period of time by the aforementioned four surgeons and another four experienced on-pump surgeons who performed >95% of their surgeries on-pump. The OPCAB surgeon group had a mixed practice with 30–35% of their CABG practice consisting of OPCAB cases. All surgeons who participated in the study had already performed more than 700 CABG cases and more than 1000 cardiac surgery procedures. CABG surgeries performed by less experienced surgeons or trainee first operators were excluded from the study.
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