Off-pump coronary artery surgery is the future of coronary bypass surgery?

Objective: In the last few years, off-pump coronary artery bypass grafting (OPCAB) has gained widespread diffusion and being increasingly reported to show better outcomes compared with conventional on pump coronary artery bypass surgery, despite the lack of sufficient evidence from randomized trials. We examined our early experience with this technique mainly in high risk, elderly and multivessel coronary artery disease patients.

Methods: Between 2000.01.01 and 2005.12.31, 3461 consecutive patients underwent isolated coronary artery bypass surgery at our institutions. 2098 (60.6%) of these procedures were performed off-pump. In the last two years 91.9% of coronary artery disease patients were operated on without extracorporeal circulation. The target arterial occlusion time was about 10min (ranging 5–25min). The male: female ratio was 1.9 : 1. The mean age was 64.2±0.8 years, ranging from 18 to 83 years. 33.6% of the patients were aged 70 years and older. There were no exlusion criterion (like LMS stenosis, intramyocardial coronary artery or emergency procedure ect.).

Results: On average, 2.74±0.7 grafts per patient were completed in the our OPCAB patients (ranging 1–6 distal anastomoses). Perioperative mortality rates was 1.15% and the perioperative myocardial infarction ratio was 4.05%. Intraopertaive conversion was neceserry in 12 cases (0.57%) because of hemodynamic instability or inadequate visualization.

Conclusions: OPCAB surgery is safe and effective in patients with multivessel coronary artery disease. This type of coronary artery bypass surgery is associated with reduced transfusion and blood products requirements, slightly reduced postoperative length of ICU and hospital stay and there is a significant reduction in morbidity and mortality.