Approximately 30% of coronary artery bypass surgeries are done off-pump in the United States. Recent studies show some benefits of off-pump coronary artery bypass (OPCAB) surgery. This benefit is more significant in a selected group of patients. Our experience has shown that all patients benefit from OPCAB. In this study we reviewed all patients with LVD (ejection fraction less than or equal to 40%) who underwent OPCAB and compared them to patients who underwent conventional coronary artery bypass (CCAB).
Data from our prospective computerized database were collected and analyzed in a retrospective manner between 2000 and 2002. Patients with left ventricular ejection fraction less than or equal to 40% were included. Chi square test was used for categorical variables to evaluate the significance of results. For continuous variables the Wilcoxon Rank Sum Test was performed.
A total of 103 patients with LVD (ejection fraction less than or equal to 40%) underwent OPCAB as opposed to 193 CCAB. Overall morality (<1% vs. 7%) and morbility were lower in OPCAB compared to CCAB. Length of hospital stay in OPCAB was 6.68 vs. 9.82 days in CCAB (p=0.0012). Blood transfusion rate was higher in CCAB patients compared to OPCAB (p=0.010). Six patients in the CCAB group required re-exploration for operative hemorrhage compared to 1 in OPCAB (p=0.0254). OPCAB patients also had a lower incidence of postoperative respiratory failure (p=0.001) and renal failure requiring dialysis (p=0.07).
OPCAB is a safe technique with comparable morbidity or mortality compared to CCAB. In patients with LVD, the advantage of OPCAB over CCAB is more obvious. Prospective randomized studies in a larger series of patients are needed to support our findings.
OPCAB is associated with fewer complications and results in decreased morbidity and mortality in patients with LVD. It may be the procedure of choice in such patients.
Z. Rashid, None.