Off pump coronary artery bypass (OPCAB) grafting is still discussed controversially in the cardiac surgical community. Early perioperative results are encouraging. Only few reports have focused on mid-term recurrence of angina and freedom from death or re-intervention.
107 OPCAB patients (mean age 63±1 years, 77 male, mean additive EuroScore 4.1±0.3, mean logistic EuroScore 5.6±0.7%, number of distal anastomoses 2.0±0.1), operated on between January 1999 and December 2003, were systematically followed up comparing pre- and post-operative NYHA- and CCS-classifications and assessing freedom from death and re-intervention. 52 of 107 patients underwent postoperative angiography or multi-slice computed tomography (MSCT). 24 of the latter 52 patients were symptomatic, 21 with stable angina, 3 with unstable angina, the others underwent follow-up studies having given their informed consent.
Perioperative 30 day mortality was 3%. Freedom from death or re-intervention at 5.5 years was 91% and 80%, respectively. Only three patients required re-intervention in an OPCAB-related vessel. CCS classification was 2.8±0.1 before surgery and 1.8±0.2 (p<0.01) at follow-up (3.3±0.3 years). NYHA classification was 2.7±0.1 and 2.2±0.1 (p<0.01), respectively. 52 patients (24 for cardiac symptoms) underwent coronary angiography or MSCT at a mean follow-up of 2.2±0.3 years. Left internal thoracic artery was patent in 91%, venous graft patency rate was 83%.
In this small but consecutive OPCAB population with a considerable perioperative risk according to the EuroScore, freedom from death and re-intervention at 5.5 years is acceptable and graft patency rate at 2.2±0.3 years is in the expected range. Significant reduction in both CCS and NYHA classification indicate sustained clinical improvement at mid-term.
Even with a low case load, reserving OPCAB to selected indications, surgery can be performed at low operative mortality and acceptable mid-term results.
Parwis Massoudy, None.