Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients

Background. This retrospective study compared clinical outcomes and resourc e utilization in patients having off-pump coronary artery bypass grafting ( OPCAB) versus conventional coronary artery bypass grafting (CABG). Angiogra phic patency was documented in the OPCAB group. Methods. From April 1997 through November 1999, OPCAB was performed in 200 consecutive patients, and the results were compared with those in a contemp oraneous matched control group of 1,000 patients undergoing CABG. Patients were matched according to age, sex, preexisting disease (renal failure, dia betes, pulmonary disease, stroke, hypertension, peripheral vascular disease , previous myocardial infarction, and primary or redo status. Follow-up in the OPCAB patients was 93% and averaged 13.4 months. Results. Hospital death (1.0%), postoperative stroke (1.5%), myocardial inf arction (1.0%), and re-entry for bleeding (1.5%) occurred infrequently in t he OPCAB group. There were reductions in the rates of transfusion (33.0% ve rsus 70.0%; p < 0.001) and deep sternal wound infection (0% versus 2.2%; p = 0.067) in the OPCAB group compared with the CABG group. Angiographic asse ssment of 421 grafted arteries was performed in 167 OPCAB patients (83.5%) prior to hospital discharge. All but five were patent (98.8%) (93.3% FitzGi bbon A, 5.5% FitzGibbon B, 1.2% FitzGibbon O). All 163 internal mammary art ery grafts were patent. Off-pump coronary artery bypass grafting reduced po stoperative hospital stay from 5.7 +/- 5.3 days in the CABG group to 3.9 +/ - 2.6 days (p < 0.001), with a decrease in hospital cost of 15.0% (p < 0.00 1). Conclusions. Off-pump coronary artery bypass grafting reduces hospital cost , postoperative length of stay, and morbidity compared with CABG on cardiop ulmonary bypass. Off-pump coronary bypass grafting is safe, cost effective, and associated with excellent graft patency and clinical outcomes. (Ann Th orac Surg 2001;71:1477-84) (C) 2001 by The Society of Thoracic Surgeons.