Myocardial revascularization with and without cardiopulmonary bypass in multivessel disease patients

Off-pump coronary artery bypass surgery is widely performed because of its proved safety, but its effectiveness remains controversial. The aim of this retrospective study was to compare early and late results in patients with multivessel disease, operated on off-pump and on-pump.From November 1994 to December 2001, 2957 patients with multivessel disease underwent isolated coronary revascularization, on-pump (n = 1924) and off-pump (n = 1033). Sixty-five patients (2.2%) who were converted from off-pump to on-pump were considered as part of the off-pump group.Stepwise logistic regression analysis showed that the use of cardiopulmonary bypass was an independent predictor for early death, early negative primary endpoints, and early major events. Conversion to on-pump was an independent risk factor for a higher incidence of death due to any cause and cardiac death, early negative primary endpoints, and early major events. Conversion, however, did not affect late clinical outcome. The 6-year freedom from death (any cause, cardiac cause), myocardial infarction, redo/coronary angioplasty and any events was similar in the two groups.These results suggest that off-pump surgery reduces early mortality and morbidity. These benefits are not at the expense of the long-term clinical outcome which seems to be similar in the two groups. Patients who require conversion from off-pump to on-pump have a much higher mortality and morbidity although this does not seem to influence their long-term clinical outcome.