Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting.

OBJECTIVE To compare the short-term outcomes in selected high-risk patients underwent off-pump coronary artery bypass grafting (OPCAB) or on-pump conventional coronary artery bypass grafting (CCABG). METHODS Comparative analysis was made between 318 high-risk patients underwent OPCAB between January 1999 to December 2005 and 197 high-risk patients underwent CCABG between January 1999 to December 2003 and EuroSCORE was > or = 5 in all patients. RESULTS EuroSCORE was similar between the two groups (6.1 +/- 1.2 vs. 6.3 +/- 1.4 per patient). The patients in OPCAB group were significantly older [(71.1 +/- 6.0) years vs. (60.2 +/- 8.5) years, P < 0.01] and had more peripheral vascular diseases (47.8% vs. 23.4%, P < 0.01) than that in CCABG group. The OPCAB group included more patients with left ventricular ejection fraction (LVEF) > or = 50% (84% vs. 60.4%, P < 0.01) compared to CCABG group. Mean grafts per patient was 3.0 +/- 0.8 in OPCAB group and 3.6 +/- 0.9 in CCABG group (P < 0.01). Operative mortality was 1.6% (5/318) in OPCAB group and 6.1% (12/197) (P < 0.01). The total Intensive Care Unit (ICU) time was (90 +/- 169) hours for OPCAB patients and (126 +/- 187) hours for CCABG patients (P < 0.05). The total ventilator support time was (21 +/- 45) hours for OPCAB and (54 +/- 170) hours for CCABG patients (P < 0.01). Intro-Aortic Balloon Pump (IABP) rate (2.5% vs. 10.2%, P < 0.01), rate of re-operation for cardiac reasons (1.9% vs. 5.6%, P < 0.01), rate of cerebral vascular accident (CVA) (0.3% vs. 2.5%, P < 0.05) and cardiac arrest rate (2.8% vs. 6.6%, P < 0.05) were all less in OPCAB group compared to CCABG group. CONCLUSION Compared to CCABG, OPCAB significantly reduces post operation ICU time, ventilator support time, operative mortality and operative morbidity in selected high-risk patients.