Early and midterm results after coronary artery bypass grafting with and without cardiopulmonary bypass: which patient population benefits the most?

Background: We present our early and midterm results with off-pump coronary artery bypass grafting (OPCAB) on the beating heart and with conventional coronary artery bypass grafting (CABG) and compare patient outcomes for both procedures.
Methods: Between November 1997 and April 2001, OPCAB was performed in 330 patients. The results were compared with those of a matched population of 330 patients who had undergone CABG during the same period. Specific postoperative outcomes were evaluated for patient subgroups with multimorbidity, with impaired ventricular function, of an older age, and of a young age without comorbidities. Midterm results and quality-of-life (QOL) scores for patients were obtained by follow-up.
Results: In the overall series, OPCAB resulted in signifi- cantly shorter surgery times (P =.008), ventilation times (P <.001), intensive care unit (ICU) stays (P <.001), and hospital stays (P =.006). OPCAB also resulted in less postoperative inotropic medication (P =.041), lower transfusion rates (P <.001), fewer postoperative myocardial infarctions (P =.038), and lower hospital mortality rates (P =.024). Among the patient subgroups, patients with multimorbidities were the only subgroup to show a significant reduction in hospital mortality after OPCAB surgery (P =.048). Times of postoperative ventilation, ICU stay, and hospitalization were significantly reduced for all patient subgroups (P <.05). After mean followup times of 43.8 months (OPCAB) and 44.8 months (CABG), QOL scores, midterm complication rates, and mortality rates were not significantly different among the groups.
Conclusion: OPCAB surgery improved postoperative recovery for the entire patient population without compromising midterm outcome. Compared with conventional CABG, high-risk patients with multimorbidity particularly profit from avoiding cardiopulmonary bypass and show significantly lower hospital mortality.