Abstract
Background. Cardiopulmonary bypass initiates a cascade of inflammatory processes that may result
in end-organ damage, leading to the increased prevalence of noncardiac complications.
Therefore, off-pump coronary artery bypass graft (OP-CAB) procedures have recently
been introduced into clinical practice. Methods. This study was a case-controlled study that compared the outcomes and cost of 100
consecutive OP-CAB procedures with a control group of 100 contemporary matched conventional
coronary artery bypass grafting procedures. All operations were performed by a single
surgeon (J.H.L.) and complete revascularization that used off-pump techniques was
achieved with the use of innovative exposure techniques to the lateral and posterior
wall vessels. Results. An average of 3.1 grafts per patient were performed in the OP-CAB group (range, 1-5).
The incidence of conversion to conventional coronary artery bypass grafting was 1%.
The overall mortality rate was 2.0%. There were no instances of stroke, renal failure,
or sternal infections in the OPCAB group. Thus, the OP-CAB group had a shorter length
of stay (6.1 ± 2.5 versus 7.1 ± 3.3 d; P =.003), with a corresponding reduction in variable direct cost per case of 29% (P <.001). Conclusion. Our experience suggests that OP-CAB procedures are feasible for most patients who
currently require complete revascularization. It is associated with very a low morbidity
rate and may represent the ideal revascularization strategy for patients at high risk
for undergoing cardiopulmonary bypass. (Surgery 2000;128:548-55.)
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Article info
Footnotes
*Supported in part by honorariums (J.H.L. and M.C.) from Medtronics, Inc, for peer-to-peer training with the Octopus device.
**Reprint requests: Jai H. Lee, MD, Division of Cardiothoracic Surgery, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH 44106.
★Surgery 2000;128:548-55
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
