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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- Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial.J Thorac Cardiovasc Surg. 1996; 112: 755-764
- Cost analysis of early extubation after coronary bypass surgery.Surgery. 1996; 120: 611-619
- Fast track recovery of elderly coronary bypass surgery patients.Ann Thorac Surg. 1999; 68: 437-441
- A two-year, three institution experience with the Medtronic Octopus: systematic off-pump surgery.Ann Thorac Surg. 1999; 68: 1478-1481
- To use or not use the pump oxygenator in coronary bypass operations.Ann Thorac Surg. 1975; 19: 108-109
- Mammary artery-coronary artery anastomosis as method of treatment for angina pectoris.J Thorac Cardiovasc Surg. 1967; 54: 535-544
- The LAST operation: techniques and results before and after the stabilization era.Ann Thorac Surg. 1998; 66: 998-1001
- Coronary artery bypass grafting without cardiopulmonary bypass.Ann Thorac Surg. 1996; 61: 63-66
- Minimally invasive direct coronary artery bypass grafting: two-year clinical experience.Ann Thorac Surg. 1997; 64: 1648-1655
- Coronary artery bypass without cardiopulmonary bypass.Ann Thorac Surg. 1992; 54: 1085-1092
- Systematic off-pump coronary artery revascularization: experience of 275 cases.Ann Thorac Surg. 1999; 68: 1494-1497
- Adverse cerebral outcomes after coronary bypass surgery: multicenter study of perioperative ischemia research group and the ischemia research and education foundation investigators.N Engl J Med. 1996; 335: 1857-1863
- On-pump versus off-pump coronary revascularization: evaluation of renal function.Ann Thorac Surg. 1999; 68: 2237-2242
- Cost-effectiveness of minimally invasive coronary artery bypass surgery.Ann Thorac Surg. 1999; 68: 1562-1566
- Off-pump surgery decreases postoperative complications and resource utilization in the elderly.Ann Thorac Surg. 1999; 68: 1490-1493
*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.
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.