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

ABSTRACT

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