Patients and complication with off-pump vs. on-pump cardiac surgery - a single surgeon experience.

Background: Off-pump operations (OPCAB) are growingly used for patients with coronary artery disease (CAD) and may be associated with improved outcomes when compared with coronary artery bypass grafting (CABG) using extracorporeal circulation (ECC), especially in patients with comorbidities. The aim of this study is to compare the intra- and postoperative results of OPCAB complete arterial myocardial revascularization with standard on-pump CABG under respect of comorbidities.

Methods: We report about the implementing of the off-pump technique in our institution from November 2004 to May 2006. Sixty-two patients with CABG in off-pump technique were compared to a control group of 129 patients with CABG using ECC. The off-pump technique was mostly used in patients with vascular and pulmonary diseases. All operations were performed by the same surgeon. All off-pumps were performed using both internal thoracic arteries (ITA) or left ITA and radial artery (RA) in T-graft technique, while in the on-pump group only the LITA and saphenous vein were used. The conversion rate from OPCAB to conventional CABG was 3.2% (two patients).

Results: Peripheral vascular disease (PVD) and chronic obstructive pulmonary disease (COPD) were significant more often in the off-pump group. Other preoperative risk factors were comparable between the groups. Operation time was significantly longer in the off-pump group. Postoperative symptomatic transient psychotic syndromes were more often in the on-pump group. Outcome was similar, despite significant longer operation time in off-pump group.

Conclusion: Off-pump coronary artery surgery can be performed in patients with comorbidities with similar outcome compared to on-pump surgery.