Off-pump versus on-pump coronary artery bypass grafting: 7-years of experience at a single institution

Off-pump coronary artery bypass [OPCAB] grafting was introduced in our institution in 2000; since then 460 [29%] of 1540 CAB grafting cases have been done. The objective of this study was to compare outcome measures between the OPCAB and on-pump coronary artery bypass [ONCAB] grafting in Saudi patients. This was a retrospective observational study done for patients who underwent coronary artery bypass grafting in the period from January 2000 to July 2007 in our institution. The mean age of patients was 58.1 +/- 19 years with no difference between the two groups. The mean Euro-score was 2.9 in the ONCAB vs. 2.5 in the OPCAB group. The 30-day mortality was 14.2 [3.1%] in the OPCAB versus 37 [3.5%] for the ONCAB [p=0.6]. Perioperative MI was not significantly different between the two groups [6% in OPCAB vs. 8% in ONCAB patients]. De-novo renal impairment developed in 9 OPCAB cases [2%][and in 75 ONCAB cases [7%] [p=0.02]. there was no difference between the groups in improvement or deterioration in preoperatively impaired renal function. Stroke rate was 2% in the ONCAB cases versus none for the OPCAB cases. Significant CCU psychosis was much lower in the OPCAB group [23[5%] vs. 140[13%]] [p=0.004]. There was no significant difference in the number of grafts between the two groups [2.1 in OPCAB vs., 2.6 in ONCAB]. Re-exploration for bleeding was needed in 3.3% in the OPCAB cases versus 5.5% in the ONCAB group [p=0.01]. The mean length of hospital stay [LOHS] was 9.2 +/- 3 days in the ONCAB versus 7.4 +/- 3.4 days in the OPCAB cases [p=0.05]. OPCAB provided no survival advantage, but did show a renal protective advantage, and less incidence of stroke, a shorter LOHS and al lower incidence of CCU psychosis

Coronary artery bypass grafting in elderly Saudi patients

The mean age for patients undergoing coronary artery bypass grafting [CABG] and other cardiac surgery procedures is increasing. Our patient population in Saudi Arabia differs in important respects from populations reported in western medical literature, for example, there is high incidence of diabetes mellitus and the more sedentary lifestyle. In this study we intend to evaluate the outcome of CABG in Saudi patients aged seventy years and above, to obtain grounds for patients' counseling and surgical decision making. The perioperative data of 189 patients aged seventy years and above who underwent isolated CABG in the period from January 1999 to December 2005 were retrospectively evaluated and compared to those who were below seventy. Patients having additional valve procedure were examined separately to determine the impact of this combination on the surgical risk. There were 189 patients aged seventy and above [14%] out of a total of 1400 patients who underwent isolated CABG. The in hospital mortality of this group was 14 deaths [7.4%]. In the group aged less than 70 years the mortality was 2.3% [p-value=0.02]. Thirty nine patients aged 70 and over underwent an associated valve procedure and the in hospital mortality in this group was 12 deaths [30.8%] compared with 4% in the younger age group. Elderly females who underwent a combined CABG and valve surgery had a 46.5% in hospital mortality [Odd ratio= 2.1, and 95% CI=1.2-4.1]. Elderly Saudi patients have a high mortality when they undergo a combined CABG and valve procedure. Female gender significantly affects the mortality in these patients