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Comparative Study
. 2003 Jan;75(1):62-7.
doi: 10.1016/s0003-4975(02)04116-4.

On-pump coronary artery surgery versus off-pump exclusive arterial coronary grafting: a matched cohort comparison

Michael Haase  1 , Anamika Sharma, Anja Fielitz, Shigehiko Uchino, Jens Rocktaeschel, Rinaldo Bellomo, Laurie Doolan, George Matalanis, Alexander Rosalion, Brian F Buxton, Jai S Raman
Affiliations
Comparative Study

On-pump coronary artery surgery versus off-pump exclusive arterial coronary grafting: a matched cohort comparison

Michael Haase et al. Ann Thorac Surg. 2003 Jan.

Abstract

Background: It is unknown whether coronary artery bypass grafting without cardiopulmonary bypass and with exclusive use of arterial grafts (arterial off-pump CABG) offers any significant short-term advantages over standard CABG with cardiopulmonary bypass. Accordingly, we performed a comparison of the short-term outcomes of arterial off-pump and standard CABG patients matched for preoperative risk and number of grafts.

Methods: We studied 90 consecutive arterial off-pump CABG patients during a 2-year period, obtained demographic and clinical features and surgical characteristics, and calculated their predicted surgical risk (EuroSCORE). Using a database of 750 contemporaneous patients treated with standard CABG, we created a matched cohort of 90 patients using an iterative process prioritizing number of grafts, target vessels, EuroSCORE, age, and sex. We compared the two groups for baseline features and short-term clinical outcomes.

Results: There were no differences in age (65.9 versus 64.7 years), sex, EuroSCORE (3.3 versus 3. 6), number of grafts (2.1 versus 2.1), and preoperative left ventricular function. Arterial off-pump CABG, however, was associated with decreased duration of operation (213 versus 252 minutes; p < 0.0013), decreased peak postoperative troponin I levels (mean, 10.8 versus 29.1 ng/mL; p < 0.0001), decreased peak norepinephrine dose (2.3 versus 4.1 microg/ min; p < 0.0082), and decreased likelihood of receiving red blood cell transfusion (17.8% versus 40%; p = 0.0016). There were no differences in duration of intensive care unit or hospital stay, incidence of atrial fibrillation, or other clinical complications. There was one death in each group.

Conclusions: After matching for number of grafts and other important preoperative risk markers, arterial off-pump CABG still decreases the need for red blood cell transfusion and offers other moderate clinical advantages compared with standard on-pump CABG.

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