Beating heart versus conventional single-vessel reoperative coronary artery bypass

Background. Reoperative (redo) coronary artery bypass grafting (CABG) with cardiopulmonary bypass (on-pump) is associated with a higher morbidity and mortality than first-time CABG. Tt is unknown, however, whether CABG withou t cardiopulmonary bypass (off-pump) may yield an improved clinical outcome over conventional on-pump redo CABG, Methods. We compared the perioperative outcomes of patients with single-ves sel disease who underwent on-pump (n = 41) versus off-pump (n = 91) redo CA BG between April 1992 and July 1999. The two groups were similar with respe ct to baseline characteristics and risk stratification: mean Parsonnet scor es were 26 +/- 9 for on-pump versus 24 +/- 8 for off-pump patients (p = non significant). Results. On-pump redo patients had a higher rate of postoperative transfusi ons (58% on-pump versus 27% off-pump, p = 0.001), prolonged ventilatory sup port (17% on-pump versus 4% oh-pump, p = 0.03), and a higher rate of postop erative atrial fibrillation (29% on-pump versus 14% off-pump, p = 0.04). On -pump redo CABG was also associated with prolonged postoperative length of stay (8 +/- 4 days on-pump versus 5 +/- 2 days off-pump, p < 0.001). In-hos pital mortality was significantly higher in on-pump than in off-pump patien ts (10% versus 1%, p = 0.03). Conclusions. Single-vessel off-pump redo CABG can be performed safely with a lower operative morbidity and mortality than on-pump CABG and an abbrevia ted hospital stay compared with conventional on-pump redo CABG. (C) 2000 by The Society of Thoracic Surgeons.