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DOI: 10.1055/s-2007-967524
Off-pump coronary surgery improves outcome in high-risk patients with critical left main disease
Aims: A retrospective study on patients with critical left main disease who underwent either off-pump (OPCAB) or on-pump (CCAB) coronary surgery.
Methods: 449 patients were included: 247 underwent OPCAB, 202 CCAB. Uni/multivariate analyses were performed for in-hospital events. Overall survival and freedom from cardiac events were determined by Kaplan-Meier. Linearized rates of follow-up complications were compared.
Results: Overall 30-day mortality was 4.7% (expected mortality based on EuroSCORE was 8.1%). Postoperative outcome showed significant difference in operative mortality (6.9% CCAB, 2.8% OPCAB, p=0.04), in low output-syndrome (17.3% CCAB, 10.0% OPCAB, p=0.03) and hospital stay (11.9±10.7 CCAB, 9.0±6.8 OPCAB, p=0.001). Incidence of neurological complications (3.0% CCAB, 2.1% OPCAB, p=n.s.) and neurocognitive deficit (3.5% CCAB, 1.2% OPCAB, p=n.s.) was lower in OPCAB. Cerebral ischemic events were absent in those patient in whom no manipulation of the aorta was performed. Incidence of renal failure was lower in OPCAB (4.5% CCAB, 2.6% OPCAB, p=n.s.). Kaplan-Meier survival at 40 months was 92±2% for OPCAB, 91±2% for CCAB (p=n.s.). Actuarial freedom from cardiac events at 40 months was 92±2% for OPCAB, 93±2% for CCAB (p=n.s.). The linearized rate of overall death was 3.3±0.6%/year in CCAB, 3.6±0.9%/year in OPCAB (p=n.s.). Linearized rate of cardiac events was 5.4±0.8%/year for CCAB, 6.0±1.1%/year for OPCAB (p=n.s.).
Conclusions: Our study demonstrated that patients with left main disease can safely undergo OPCAB, with an improved outcome and an event-free follow-up.