Off-pump coronary artery bypass grafting decreases risk-adjusted mortalityand morbidity

Background. The purpose of this study was to determine whether coronary art ery bypass grafting without cardiopulmonary bypass (off-pump CABG) decrease s risk-adjusted operative death and major complications after coronary arte ry bypass grafting in selected patients. Methods. Using The Society of Thoracic Surgeons (STS) National Adult Cardia c Surgery Database, procedural outcomes were compared for conventional and off-pump CABG procedures from January 1, 1998, through December 31, 1999. M ortality and major complications were examined, both as unadjusted rates an d after adjusting for known base line patient risk factors. Results. A total of 126 experienced centers performed 118,140 total CABG pr ocedures. The number of off-pump CABG cases was 11,717 cases (9.9% of total cases). The use of an off-pump procedure was associated with a decrease in risk-adjusted operative mortality from 2.9% with conventional CABG to 2.3% in the off-pump group (p < 0.001). The use of an off-pump procedure decrea sed the risk-adjusted major complication rate from 14.15% with conventional CABG to 10.62% in the off-pump group (p < 0.0001). Patients receiving off- pump procedures were less likely to die (adjusted odds ratio 0.81, 95% CI 0 .70 to 0.91) and less likely to have major complications (adjusted odds rat io 0.77, 95% CI 0.72 to 0.82). Conclusions. Off-pump CABG is associated with decreased mortality and morbi dity after coronary artery bypass grafting. Off-pump CABG may prove superio r to conventional CABG in appropriately selected patients. (C) 2001 by The Society of Thoracic Surgeons.