A Comparative Study Of Off-pump Coronary Artery Bypass Grafting (OPCAB) And On-pump Coronary Artery Bypass Grafting (CCAB)

Objective:Compare the vascular anastomosis and the perioperative effects of coronary artery bypass grafting (CABG) operation with and without pulmonary bypass (CCAB and OPCAB), evaluate the short-term outcome of the two methods.Methods:In 151 patients undergoing CABG in cardiothoracic surgery department of Tianjin medical university general hospital during 1999 to 2003, one group performed CABG with CPB and the other group without CPB. The position that graft vascular anastomosed, postoperative mechanic ventilation time, ICU time, complication rate, total maxinum systemic organ failure score and organ peak score(TMS, PS) and death rate were compared.Results:The two groups did not differ with respect to preoperative data such as age, sex, complications and myocardial disease. The CCAB group has more number of anastomosis against OPCAB group(3.33 +0.847 vs 2.52 + 0.910, P<0.05), and the two groups have the similar distribution of target position of anastomosis. In the CCAB group, the mechanic ventilation time(12.67+8.48 vs 8.26 +5.04 hour, p<0.05) and ICU time(7.81 +3.62 vs 6.23 + 4.71 day, p<0.05) is significant higher than OPCAB group, the rate of myocardialcomplications is significant higher than OPCAB group (31.4% vs 17.3%, p<0.05), and the rate of pulmonary infarction (7.1% vs 0%, p<0.05) and cognition disorder (20.0% vs 8.6%, p<0.05) is higher than OPCAB group with significant too. In CCAB group the TMS SOFA score is high, and peak score (PS) of circulation and coagulation and nervous system is higher than OPCAB group. The two groups of patients have similar perioperative dead rate. The rate of myocardial complications is higher in patients undergoing CCAB complicated with DM, hypertention, recent acute myocardial infarction and heart dysfunction. The cognition disorder is more frequently in patients with hypertention undergoing CCAB.Conclution:The present study demonstrated that OPCAB has same revascularization ability vs OPCAB though it has fewer count of anastomosis, and has few postoperative complications, and equal perioperative dead rate. OPCAB is a good choice for patient with risk factors of CPB. The long-term patency rate of graft vessel in OPCAB will be observed.