Safety and efficacy of off-pump coronary artery bypass grafting

Background. We evaluated the application of the off-pump coronary artery by pass (OPCAB) procedure relative to safety and efficiency as measured by ope rative mortality postoperative complications and longitudinal outcome. Methods. Three hundred and fifty OPCAB patients were compared to 3,171 on-p ump or conventional coronary artery bypass (CCAB) patients between January 1, 1997 and December 31, 1998, The groups were divided into three preoperat ive predicted risk categories: low-risk (0 to 2.59%), medium-risk (2.6 to 9 .9%), and high-risk (greater than or equal to 10%). Society of Thoracic Sur geons National Cardiac Surgery Database definitions and predicted risk grou p models were utilized to compare all preoperative, intraoperative, and pos toperative variables using univariate analysis. Results. Overall comparison of the immediate outcome of CCAB and OPCAB show s little statistical significance in the variables analyzed. The operative mortality was 3.4% in both groups. When the immediate outcome was compared between groups (CCAB vs OPCAB), as well. as individual risk groups (low, me dium, and high), similar patterns of operative variables and postoperative complications were observed. The operative mortality in the low-risk group was 1.1% for CCAB and 1.4% for OPCAB; 7% for CCAB and 6% for OPCAB in the m edium-risk group; and in the high-risk group 28.5% for CCAB compared to 7.7 % for OPCAB group (p = 0.008). Short-term follow-up shows a trend of increa sed recurring angina and reinterventional procedures in the OPCAB patients. Conclusions, Safety for OPCAB is assessed through retrospective data review . Longitudinal follow-up for survival, reintervention, and quality of posto perative document efficacy and patency rates, compared to on-pump procedure s, is mandatory. This study documented the immediate safety of the OPCAB pr ocedure, Preliminary findings at I-year follow-up is an important finding i n this study, but it is not conclusive at this time, Long-term longitudinal follow-up is required to assess the future effectiveness of OPCAB. (C) 200 0 by The Society of Thoracic Surgeons.