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DOI: 10.1055/s-2006-924484
© Georg Thieme Verlag KG Stuttgart · New York
Off-Pump versus On-Pump Coronary Artery Bypass Surgery in High-Risk Patients (EuroSCORE ≥ 6)
Publication History
received April 11, 2006
Publication Date:
06 February 2007 (online)
![](https://www.thieme-connect.de/media/thoracic/200701/lookinside/thumbnails/10.1055-s-2006-924484-1.jpg)
Abstract
Objective: The aim of this study was to review the results of off-pump (OPCAB) versus conventional on-pump coronary artery bypass surgery (CCAB) in high-risk patients. Methods: In a cohort of patients with an additive EuroSCORE ≥ 6, 67 underwent OPCAB and 112 underwent CCAB. Results: Thirty-day postoperative death and stroke rates were 7.5 % and 6.0 % for the OPCAB group, and 5.4 % (p = 0.75) and 8.0 % (p = 0.77) for the CCAB group, respectively. No significant differences were observed for other major outcome endpoints other than cardiac troponin I (OPCAB: 117 ± 428 ng/ml vs. CCAB: 58 ± 99 ng/ml, p = 0.028), a result which was probably due to preoperative massive myocardial infarction in two very high-risk patients who underwent OPCAB. A similar outcome was also observed among propensity score-matched pairs. Congestive heart failure (p = 0.006, OR: 6.366, 95 % CI: 1.682 - 24.093) and baseline cardiac index (p = 0.018, OR: 0.171, 95 % CI: 0.040 - 0.735) were independent predictors of 30-day postoperative mortality. Conclusions: OPCAB can be safely performed in high-risk patients with results as satisfactory as those achieved with CCAB.
Key words
cardiovascular surgery - heart disease - coronary bypass surgery
References
- 1 Wijeysundera D N, Beattie W S, Djaiani G. et al . Off-pump coronary artery surgery for reducing mortality and morbidity: meta-analysis of randomized and observational studies. J Am Coll Cardiol. 2005; 46 872-882
- 2 Cheng D C, Bainbridge D, Martin J E, Novick R J. Evidence-Based Perioperative Clinical Outcomes Research Group . Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology. 2005; 102 188-203
- 3 Puskas J D, Williams W H, Mahoney E M. et al . Off-pump vs. conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial. JAMA. 2004; 291 1841-1849
- 4 Stamou S C, Corso P J. Coronary revascularization without cardiopulmonary bypass in high-risk patients: a route to the future. Ann Thorac Surg. 2001; 71 1056-1061
- 5 Sharony R, Bizekis C S, Kanchuger M. et al . Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: a case control study. Circulation. 2003; 108 (Suppl 2) 15-20
- 6 Srinivasan A K, Grayson A D, Fabri B M. On-pump versus off-pump coronary artery bypass grafting in diabetic patients: a propensity score analysis. Ann Thorac Surg. 2004; 78 1604-1609
- 7 Stamou S C, Jablonski K A, Hill P C, Bafi A S, Boyce S W, Corso P J. Coronary revascularization without cardiopulmonary bypass versus the conventional approach in high-risk patients. Ann Thorac Surg. 2005; 79 552-557
- 8 Yokoyama T, Baumgartner F J, Gheissari A, Capouya E R, Panagiotides G P, Declusin R J. Off-pump versus on-pump coronary bypass in high-risk subgroups. Ann Thorac Surg. 2000; 70 1546-1550
- 9 Akpinar B, Guden M, Sanisoglu I. et al . Does off-pump coronary artery bypass surgery reduce mortality in high risk patients?. Heart Surg Forum. 2001; 4 231-236
- 10 Al-Ruzzeh S, Nakamura K, Athanasiou T. et al . Does off-pump coronary artery bypass (OPCAB) surgery improve the outcome in high-risk patients? A comparative study of 1398 high-risk patients. Eur J Cardiothorac Surg. 2003; 23 50-55
- 11 Chamberlain M H, Ascione R, Reeves B C, Angelini G D. Evaluation of the effectiveness of off-pump coronary artery bypass grafting in high-risk patients: an observational study. Ann Thorac Surg. 2002; 73 1866-1873
- 12 Dewey T M, Herbert M A, Prince S L. et al . Avoidance of cardiopulmonary bypass improves early survival in multivessel coronary artery bypass patients with poor ventricular function. Heart Surg Forum. 2004; 7 45-50
- 13 Goldstein D J, Beauford R B, Luk B. et al . Multivessel off-pump revascularization in patients with severe left ventricular dysfunction. Eur J Cardiothorac Surg. 2003; 24 72-80
- 14 Mack M J, Pfister A, Bachand D. et al . Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. J Thorac Cardiovasc Surg. 2004; 127 167-173
- 15 Meharwal Z S, Trehan N. Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction. Heart Surg Forum. 2002; 5 41-45
- 16 Ascione R, Narayan P, Rogers C A, Lim K H, Capoun R, Angelini G D. Early and midterm clinical outcome in patients with severe left ventricular dysfunction undergoing coronary artery surgery. Ann Thorac Surg. 2003; 76 793-799
- 17 Nashef S A, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999; 16 9-13
- 18 Chemla D, Castelain V, Humbert M. et al . New formula for predicting mean pulmonary artery pressure using systolic pulmonary artery pressure. Chest. 2004; 126 1313-1317
- 19 Gaudino M, Glieca F, Alessandrini F. et al . High risk coronary artery bypass patient: incidence, surgical strategies, and results. Ann Thorac Surg. 2004; 77 574-579
MD, PhD Fausto Biancari
Division of Cardiothoracic and Vascular Surgery
Department of Surgery
Oulu University Hospital
P. O. Box 21
90029 Oulu
Finland
Phone: + 35 8 83 15 28 13
Fax: + 35 8 83 15 25 77
Email: fausto.biancari@ppshp.fi