Improved outcomes in coronary artery bypass grafting with beating-heart techniques

Abstract

Objective: Although improved outcomes for selected patients by elimination of cardiopulmonary bypass have been demonstrated, a benefit for all patients undergoing coronary artery bypass grafting by all surgeons has yet to be definitively proved.

Methods: We reviewed our experience with beating-heart surgery from its inception in January 1995 through December 2000. A total of 12,540 patients underwent isolated coronary artery bypass grafting, including 1915 procedures (15%) performed without cardiopulmonary bypass. Groups were compared by univariate analysis for preoperative risk factors and postoperative complications, and predicted risk was determined by the Society of Thoracic Surgeons risk algorithm.

Results: There was a gradual increase in the percentage of coronary operations performed off pump, from 1.2% in 1995 to 34.1% in 2000. Individual surgeon adoption rates ranged from 1% to 96% by 2000. There was a decrease in mortality to 3.22%, compared with an overall observed mortality rate of 4.0% in the 5 years before beating-heart surgery (P =.0482). There was a significant difference in observed mortality between the off-pump and on-pump groups (1.9% vs 3.5%, P <.001), despite a higher mean predicted risk among the patients in the off-pump group (3.13% vs 2.8%, P <.004). Additionally, decreased morbidity in the off-pump group was evidenced by reduced needs for blood products (28.45% vs 54.65%, P =.0001), prolonged ventilation (5.83% vs 10.93%, P =.001), and reoperation for bleeding (2.41% vs 3.65%, P =.0237), and by shorter hospital stay (5.98 vs 7.32 days, P =.001).

Conclusions: Beating-heart surgery can be safely assimilated into a cardiac surgical practice, although adoption rates vary significantly among individual surgeons. Gradual integration can lead to improved outcomes in the total coronary artery bypass surgery population.