Background. Coronary artery bypass grafting without cardiopulmonary bypass
is gaining popularity as an alternative to conventional on-pump technique f
or myocardial revascularization. This includes minimally invasive direct co
ronary artery bypass (MIDCAB) and full sternotomy off-pump (OPCAB) methods.
These two approaches should be evaluated for financial and clinical approp
riateness.
Methods. Records of patients who had single or double bypass (internal mamm
ary artery and/or saphenous vein) grafts between January 1997 and June 1998
were reviewed. These included 44 MIDCAB, 62 OPCAB, and 243 conventional co
rollary artery bypass (CCAB) patients. Univariate analysis was applied to p
re, intra, and postoperative variables, comparing MIDCAB and OPCAB to the C
CAB group. Procedural cost information was obtained from participating inst
itutions.
Results. MIDCAB patients compared to CCAB patients had a higher predicted r
isk (5.4 +/- 11 versus 2.3 +/- 2.8, p 0.012) and OPCAB patients had a predi
cted risk of 5.3 +/- 7.8. MIDCAB and OPCAB procedures required less operati
ng room time and blood utilization. Observed operative mortality rates were
MIDCAB 4.5%, OPCAB 1.6%, and CCAB 2.8% (not significant). Mean hospital co
sts were CCAB at $19,000, OPCAB at $15,000, and $17,000 for MIDCAB.
Conclusions. Off pump procedures currently reflect acute episode-of-care co
st savings over CCAB. (C) 1999 by The Society of Thoracic Surgeons.