Clinical outcome and quality of life after reoperative CABG: off-pump versus on-pump - observational pilot study

Abstract

Background: Coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CBP) is associated with significant morbidity and mortality. In high-risk patients, doomed for reoperation the adverse effects of CBP may be more striking. We evaluated the results of reoperative CABG (redo-CABG) by either off-pump (OPCAB) or on-pump (ONCAB). Clinical endpoints were perioperative myocardial infarction, mortality, survival and as the most striking difference between prior studies the quality of life (QoL).

Methods: We performed a prospective, non-randomized assessment for patients who underwent redo-CABG by redo-OPCAB (n=40) or redo-ONCAB (n=40) at our institution between January 2007 and December 2010. For evaluation of QoL the SF-36 health survey was used with self-administered assessment.

Results: During follow-up 37 of 40 patients were alive in the redo-OPCAB group versus 32 of 40 patients in the redo-ONCAB group (p<0.05). The shorter operation time, less blood loss, fewer perioperative myocardial infarctions, the higher rate of totally arterial revascularisation and shorter intensive care stay were the significantly beneficial differences for patients in the redo-OPCAB group (p<0.05). The 3-year survival rate was higher in the redo-OPCAB group with 81 ± 12% versus 63 ± 9%in the redo-ONCAB group. The quality of life survey did not reveal any significant differences between both groups.

Conclusion: In conclusion, with our present retrospective study, we could demonstrate the safety and efficacy of the redo-OPCAB technique with even higher 3-year survival rate. Both techniques seem to have similar impact on the outcome of patients.

Figure 1

Kaplan-Meier analyses of cumulative survival. OPCAB, off-pump coronary artery bypass grafting; ONCAB, on-pump coronary artery bypass grafting. On the X-axis the follow-up in months and on the Y-axis the fraction survival are given. The censored event is death occurring during follow-up.

Figure 2

Kaplan-Meier analyses of composite event-free survival. OPCAB, off-pump coronary artery bypass grafting; ONCAB, on-pump coronary artery bypass grafting. On the X-axis the follow-up in months and on the Y-axis the fraction survival are given. The censored event was defined as death occurring as in-hospital mortality, early and late mortality during follow-up. The censored event was defined as dyspnea according NYHA III, angina pectoris according CCS III, MACCE, recent coronary intervention, in-hospital mortality, early and late mortality occurring during the hospital-stay and follow-up.

Figure 3

Figure 1 presents the evaluation of the quality of life or SF-36 health survey in the redo-OPCAB and redo-ONCAB patients. For this survey eight major categories were evaluated and the transformed scores were depicted on a 100 point score scale. PP, physical performance; RP, role performance; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role emotionale; MH, mental health; OPCAB, off-pump coronary artery bypass grafting; CABG, coronary artery bypass grafting; Data are expressed as mean ± standard deviation.