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J Thorac Cardiovasc Surg 2002;124:698-707
© 2002 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease (ACD) |
From the Departments of Thoracic and Cardiovascular Surgery and Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio.
Partial funding of nursing personnel for data collection of the off-pump cases was provided by Guidant Corporation, which otherwise had no input into the analyses and did not review or endorse the results reported in this study.
Read at the Eighty-first Annual Meeting of The American Association for Thoracic Surgery, San Diego, Calif, May 6-9, 2001.
Received for publication May 15, 2001. Revisions requested July 31, 2001; revisions received Oct 12, 2001. Accepted for publication Oct 24, 2001. Address for reprints: Joseph F. Sabik, MD, The Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195 (E-mail: sabikj{at}ccf.org).
Objective: To compare hospital outcomes of on-pump and off-pump coronary artery bypass surgery.
Methods: From 1997 to 2000, primary coronary artery bypass grafting was performed in 481 patients off pump and in 3231 patients on pump. Hospital outcomes were compared between propensity-matched pairs of 406 on-pump and 406 off-pump patients. The 2 groups were similar in age (P = .9), left ventricular function (P = .7), extent of coronary artery disease (P = .5), carotid artery disease (P = .4), and chronic obstructive pulmonary disease (P = .5). However, off-pump patients had more previous strokes (P = .05) and peripheral vascular disease (P = .02); on-pump patients had a higher preoperative New York Heart Association class (P = .01).
Results: In the matched pairs the mean number of bypass grafts was 2.8 ± 1.0 in off-pump patients and 3.5 ± 1.1 in on-pump patients (P < .001). Fewer grafts were performed to the circumflex (P < .001) and right coronary (P = .006) artery systems in the off-pump patients. Postoperative mortality, stroke, myocardial infarction, and reoperation for bleeding were similar in the 2 groups. There was more encephalopathy (P = .02), sternal wound infection (P = .04), red blood cell use (P = .002), and renal failure requiring dialysis (P = .03) in the on-pump patients.
Conclusions: Both off- and on-pump procedures produced excellent early clinical results with low mortality. An advantage of an off-pump operation was less postoperative morbidity; however, less complete revascularization introduced uncertainty about late results. A disadvantage of on-pump bypass was higher morbidity that seemed attributable to cardiopulmonary bypass.
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J. Thorac. Cardiovasc. Surg. 2002 124: 655-659.
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