On-pump versus off-pump coronary artery bypass grafting with left internal mammary artery for left anterior descending artery stenosis: a retrospective study over 15 years

Abstract

Backrounds The on-pump surgery might induce a higher number of postoperative complications because of the extra-corporal circulation (ECC) that is not a physiological process. Many studies have been done for over ten years to demonstrate the benefits of the off-pump surgery over the on-pump one. To date the results are still controversial. Objectives The goal of this study was to compare intraoperative characteristics and 30-day postoperative outcomes of both surgical methods. Methods Two hundred forty-three (243) patients operated under off-pump or on-pump CABG (coronary artery bypass grafting) with the left internal thoracic artery (LITA) anastomosed to the left anterior descending (LAD) coronary artery were included retrospectively in this study. We incorporated in our study operations performed from July 1997 to December 2012 in three Swiss hospitals by a single surgical team. Statistical analysis of preoperative, intraoperative and postoperative (30 days) patient characteristics were then proceeded. Results Overall patients who underwent off-pump surgery were more often men (81.5% vs 66.1%, p=0.006), were significantly older (median age 67 years old vs 64, p=0.013), had more renal failure (10.9% vs 2.4%, p=0.009) and respiratory failure (20.2% vs 7.3%, p=0.003), had more arteriopathy (16.8% vs 8.1%, p=0.038) and were affected by higher degrees of angina (p<0.001) than those who underwent on-pump surgery. Operating time was shorter in the off-pump group (median 126 min vs 160, p<0.001) but there were more urgent surgery in the on-pump group (10.5% vs 3.4%, p=0.042). There was no significant difference in the postoperative characteristics except intensive care unit stay that was shorter in off-pump group (median 1 day vs 2, p=0.046). Conclusions Both surgical techniques are safe and stackable. Thus off-pump coronary artery bypass grafting (OPCAB) is reliable for CABG performed with the LITA on the LAD coronary artery. The choice of surgical method is mainly based on the patient's comorbidities therefore off-pump surgery is often preferred for high-risk patients. It should also be noted that surgeon's habits directs the choice of the surgical technique