Advancement in technology and operative techniques has resulted in increased interest in OPCAB procedures. This, along with publicized possible side effects of cardiopulmonary bypass, raises the question, does OPCAB surgery improve the outcome over conventional coronary artery bypass (CCAB) surgery? We compared the preoperative risk profile and overall outcome of patients who underwent OPCAB in our institution to those who underwent CCAB during the same period.
Data from our prospective computerized database were collected and analyzed in a retrospective manner between 2000 and 2002. A subgroup analysis of patients >70 years was done. Chi square test was used for categorical variables to evaluate the significance of results. For continuous variables, Wilcoxon Rank Sum Test was performed.
A total of 364 patients underwent OPCAB as opposed to 866 CCAB. The overall mortality (1% vs. 3%) and morbidity (15% vs. 25%) were lower in OPCAB patients compared to CCAB, although it did not reach statistical significance, probably due to smaller numbers of study patients. Length of hospital stay in OCPAB was 6 days vs. 7 days in CCAB patients (p=0.0012). Twenty-nine patients from the CCAB group required re-exploration for postoperative hemorrhage compared to 1 in OPCAB (p=0.0254). OPCAB patients had a lower incidence of postoperative respiratory failure (p=0.002). There were 181 patients aged 70 years or older in the OPCAB group compared to 383 patients in the CCAB group. For patients >70 years the hospital mortality (p=0.010), blood transfusion rate (p=0.0003), postoperative respiratory failure (p=0.007), postoperative renal failure requiring dialysis and hospital stay (p<0.001) were significantly less for OPCAB patients.
OPCAB is a safe technique with comparable morbidity or mortality compared to CCAB. In our experience OPCAB shows a trend towards lower postoperative complication rate and mortality. This improved outcome is also seen in elderly patients (>70 years).
OPCAB may be associated with fewer complications and results in decreased morbidity and mortality. Prospective randomized studies in a larger series of patients are needed to support our findings.
T. Tak, None.