One-stage coronary and abdominal aortic operation with or without cardiopulmonary bypass: Early and midterm follow-up

Background. The aim of this study was to compare hospital, early, and late clinical outcomes for patients undergoing one-stage, coronary and abdominal aortic surgical intervention with and without cardiopulmonary bypass. Methods. From March 1990 to September 1999, 42 consecutive patients underwe nt combined operations at a single institution. Cardiopulmonary bypass and cardioplegic arrest were used during coronary revascularization in the firs t 20 patients (on-pump group), and the next 22 patients received the one-st age operations on the beating heart (off-pump group). Results. Baseline characteristics were similar between groups. Three cardia c-related hospital deaths occurred in the on-pump group and one such death in the off-pump group (p = 0.25). Cardiac-related events, pulmonary complic ations, inotropic support, blood loss and transfusion requirements, intensi ve care unit stay, and hospital stay were significantly reduced in the off- pump group (all, P < 0.05). The actuarial survival rates in the on-pump and off-pump groups were 80% and 95%, respectively, at 1 year (p = 0.13) and 7 5% and 89%, respectively, at 3 years (P = 0.22). Freedom from cardiac-relat ed events at 1-year follow-up was 91% in the off-pump group and 65% in the on-pump group (p < 0.05). No difference in cardiac-related events between g roups was observed at 3 years. Conclusions. Off-pump coronary surgical procedures decrease postoperative c omplications in high-risk patients undergoing simultaneous coronary and abd ominal aortic operations compared with the conventional one-stage procedure . The early benefits achieved with off-pump surgical intervention are not a t the expense of the long-term clinical outcome. (C) 2001 by The Society of Thoracic Surgeons.