Long-term results after systematic off-pump coronary artery bypass graft surgery in 1000 consecutive patients

Abstract

Background: Off-pump coronary artery bypass surgery (OPCAB) is currently used as an alternative to conventional "on-pump" surgery, but there are very little data available on long-term follow-up. The aim of this study was to review our long-term experience with the use of systematic OPCAB.

Methods and results: 1000 consecutive OPCAB surgeries were systematically performed between 1996 and 2004, representing 95% of all coronary revascularization during that same time frame, with a 97% complete follow-up. Average age of the patients was 64+/-10 years (778 men and 222 women). Seventy-three percent had triple-vessel disease. Operative 30-day mortality was 1.6%. Overall survival at 96 months was 74+/-3.5% and cardiac survival was 94+/-1.3%. By Cox regression analysis, age (odds ratio [OR], 1.07), congestive heart failure (CHF) (OR, 1.90), peripheral vascular disease (OR, 1.74), chronic renal insufficiency (OR, 2.04), previous myocardial infarction (MI) (OR, 1.60), and New York Heart Association functional class (OR, 1.60) were risk factors for long- term mortality. Survival free of any cardiac events (cardiac death, MI, unstable angina, heart failure, or reintervention) was 80+/-3.4%. Survival free of any type of reintervention alone was 90+/-3%. By Cox regression analysis, mitral regurgitation (OR, 2.3), peripheral vascular disease (OR, 2.1), and diffuse coronary disease (OR, 2.3) were significant predictors of recurrent cardiac events. Conversion to "on-pump" (OR, 14.3) was predictor of long-term need for repeat revascularization.

Conclusions: In this series, systematic OPCAB surgery was shown to be an acceptable alternative to conventional "on-pump" coronary artery bypass graft for the treatment of coronary artery disease.