ABSTRACT
Abstract: during the last 10-15 years, coronary artery surgery without use of cardiopulmonary bypass has gained popularity. Although worldwide incidence of off-pump surgery has remained around 15% , retrospective studies have shown that off-surgery reduces the inflammatory response, mortality and morbidity associated with coronary artery surgery
Objective: to compare early postoperative outcome in patients undergoing coronary artery surgery with or without cardiopulmonary bypass
Methods: a prospective randomized control trial was conducted in Punjab Institute of Cardiology Lahore:-Two hundred consecutive patients. Undergoing coronary artery surgery were randomized in two groups. Group I included 107 patients who underwent coronary artery bypass grafting on CPB and Group II included 93 patients who underwent coronary artery bypass grafting without CPB. Critically ill patients with hemodynamic instability, previous cardiac surgery and patients needing concomitant cardiac procedure were excluded from the study. Incidence of early postoperative [within 30 days] mortality and morbidity [myocardial infarction, bleeding, stroke, arrhythmias, renal and pulmonary complications and infection] were compared among · two groups
Results: in group I, 96 [89.71%] patients were male and 11[10.29%] were female. In group 11, 81[87.09%] patients were male and 12 [12.91%] were female. There was no significant difference in age, preoperative ejection fraction and risk factors for coronary artery disease between two groups. Routine blood tests including Hb, ESR, LFTs, RFTs, Lipid profile, bleeding profile did not show any significant difference among both groups. There was no significant difference in 30 days mortality among two groups, 2.8% in CCABG as compared to 4.3% in OPCAB [p=0.492]. No significant difference in incidence of adverse post-operative cardiac outcomes as Ml [4 [3.7%] in CCABG vs. 7 [7.5%] in OPCABJ, use of intra-aortic balloon pump [2[1.9%] in CCABG vs. 2 [2.2%] in OPCAB] and low cardiac output syndrome [2[1.9%] in CCABG vs. 1 [1.0%] in OPCABJ was found among two groups. No significant difference was observed in amount of bleeding in both groups. The incidence of pulmonary, renal and neurological complications was similar in both groups. Data regarding ICU stay [5.07+3.88 in CCABG vs. 4.23+2.11 in OPCAB] and hospital stay [12.8+8.14 in CCABG vs. 11.55+5.83 in OPCAB] showed insignificant difference
Conclusion: our study has not shown superiority of OPCAB over CCABG with regards to early mortality and morbidity which is consistent with other RCT conducted worldwide. So cautious approach is needed in widespread adoption of OPCAB