Benefits Of Off-pump Coronary Artery Bypass Grafting In Patients At Higher Risk As Estimated By EuroSCORE

Abstract:Objective To investigate which patient subgroups may benefit the most from off-pump coronary artery bypass graft (OPCAB) rather than on-pump coronary artery bypass graft (CCAB) in patients at higher risk as estimated by EuroSCORE and summary the clinical experiences. Methods211patients undergoing coronary artery bypass graft were entered into the study. A total of52patients received CCAB whereas159received OPCAB. Predicted risk of operative mortality (PROM) of each patient was calculated by EuroSCORE. Patients undergoing concomitant valvular, left ventricular, or major vascular operations were excluded from the current analysis. Patients were stratified into high-risk (PROM≥6%) tertiles. Mortality rates and the incidences of cardiovascular events were compared between CCAB and OPCAB in high risk tertiles.The general result of operation were compared between two procedures. Results The number of patients with left main disease was similar between the groups. The average number of anastomotic sites per patient was2.75±0.82in the CCAB group and2.83±0.58in the OPCAB group.30-day mortality was5.8%in the CCAB group and1.26%in the OPCAB group. The odds ratio of30-day stroke in CCAB compared with OPCAB was5.7(95%confidence interval [CI],1.28-25.09, p<0.05) in the high-risk tertile. Proportions of30-day myocardial infarction and those composite cardiovascular events were similar between the2groups in the high-risk tertile. Conclusions Mortality and the average number of anastomotic sites was not significantly different between CCAB and OPCAB patients. OPCAB can reduce bleeding and transfusion. Benefit of OPCAB was shown in the time of operation, ICU stay and ventilation.OPCAB as opposed to CCAB is associated with short-term benefits in stroke prevention in patients at higher risk as estimated by EuroSCORE.