Off-Pump versus On-Pump Coronary Artery Bypass Surgery in High-Risk Patients (EuroSCORE ≥ 6)

Abstract

Objective: The aim of this study was to review the results of off-pump (OPCAB) versus conventional on-pump coronary artery bypass surgery (CCAB) in high-risk patients. Methods: In a cohort of patients with an additive EuroSCORE ≥ 6, 67 underwent OPCAB and 112 underwent CCAB. Results: Thirty-day postoperative death and stroke rates were 7.5 % and 6.0 % for the OPCAB group, and 5.4 % (p = 0.75) and 8.0 % (p = 0.77) for the CCAB group, respectively. No significant differences were observed for other major outcome endpoints other than cardiac troponin I (OPCAB: 117 ± 428 ng/ml vs. CCAB: 58 ± 99 ng/ml, p = 0.028), a result which was probably due to preoperative massive myocardial infarction in two very high-risk patients who underwent OPCAB. A similar outcome was also observed among propensity score-matched pairs. Congestive heart failure (p = 0.006, OR: 6.366, 95 % CI: 1.682 - 24.093) and baseline cardiac index (p = 0.018, OR: 0.171, 95 % CI: 0.040 - 0.735) were independent predictors of 30-day postoperative mortality. Conclusions: OPCAB can be safely performed in high-risk patients with results as satisfactory as those achieved with CCAB.

cardiovascular surgery - heart disease - coronary bypass surgery

References

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