Abstract: Poster Presentations |

Off-Pump Coronary Artery Bypass Reduces Mortality and Morbidity in a Community Hospital Setting FREE TO VIEW

Christopher T. Strzalka, MD*; James Donnelly, BA; Dennis M. Michalak, MD; Michael D. Butler, MD; Jay Williams; Joseph R. McClellan, MD
Author and Funding Information

Hamot Heart Institute, Erie, PA


Chest. 2004;126(4_MeetingAbstracts):829S-b-830S. doi:10.1378/chest.126.4_MeetingAbstracts.829S-b
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PURPOSE:  Although off-pump coronary artery bypass (OPCAB) may result in improved clinical outcomes, there has been limited clinical adoption of this technique in the US. Further comparison of OPCAB with conventional on-pump coronary artery bypass (CABG) is needed to define and enhance ideal patient selection, especially as applied in routine clinical practice.

METHODS:  Comparative data was collected and analyzed on 2,471 consecutive patients (933 OPCAB, 1538 CABG) who underwent isolated coronary artery bypass between January 1, 2000 and December 31, 2003, at a single community hospital. The vast majority of OPCAB procedures were performed by a single surgeon (CS) who does OPCAB almost exclusively. Patient selection for OPCAB was based on individual surgeon preference.

RESULTS:  OPCAB and CABG patients were similar in age, gender, LV function, presence of left main coronary artery disease and most co-morbid conditions. CABG patients had a greater average number of grafts performed. Overall 4-year surgical mortality was 1.2%. OPCAB mortality was 0.6% versus 1.5% for CABG (Relative Risk (RR) 0.43, 95% Confidence Interval (CI) 0.17-1.05). There was less post-op respiratory failure with OPCAB (OPCAB 2.9% vs CABG 3.8%; RR 0.75, CI 0.48-1.18) in spite of the higher incidence of preop COPD. OPCAB patients also had lower rates of post-op sternal wound infection (OPCAB 1.0% vs CABG 1.8%; RR 0.52, CI 0.25-1.12), acute renal failure (OPCAB 0.4% vs CABG 1.0%; RR 0.41, CI 0.14-1.22), return to OR (OPCAB 1.3% vs CABG 1.9%; RR 0.68, CI 0.35-1.33), post-op stroke (OPCAB 1.2% vs CABG 1.5%; RR 0.78, CI 0.39-1.61), and post-op MI (OPCAB 0.3% vs CABG 0.7%; RR 0.49, CI 0.14-1.79).

CONCLUSION:  Although overall outcomes for CABG were excellent, OPCAB applied in a community hospital setting resulted in a substantial reduction in surgical mortality and morbidity. Patient selection bias may have influenced the outcomes, however our results affirm the value of OPCAB in routine clinical practice.

CLINICAL IMPLICATIONS:  The learning-curve for OPCAB is steep, and surgeon experience must be factored into any comparative trial conducted in the future. VariablesOpcabPercentCabgPercentNumber93337%153862%Age6665Woman31334%45329%Mortality60.6%231.5%Obesity9210%18312%Pul Htn414%372%COPD21123%19313%EF< 40%29231%44329%CHF323%413%Renal Dis616%463%Redo293%775%Left Main19621%34022%# of Grafts3.03.9Lad Disease85492%142993%Circ Disease67072%128483%RCA Disease73879%134087%

DISCLOSURE:  C.T. Strzalka, None.

Wednesday, October 27, 2004

12:30 PM - 2:00 PM




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