Off Pump Coronary Artery Bypass (OPCAB) is Safe & Cost Effective in High Risk Patients

Background: Cardiopulmonary bypass (CPB) is associated with diffuse systemic inflammatory responses during and after cardiac surgery and is associated with increased morbidity & mortality associated with Coronary Artery Bypass Grafting CABG, particularly in high risk sub set of patients i.e., advanced age, severe left ventricular dysfunction, renal failure, etc. The purpose of this study is to analyze the results of OPCAB in high-risk patients and compared them with results of CABG on-pump (ie, conventional CABG) in a similar group of patients Methods: Over a 3-year period the 51 high risk patients were operated at social security hospital These patients underwent coronary revascularization were divided in 2 groups, group A CABG & group B without cardiopulmonary bypass OPCABG. Data were prospectively collected on patients who were undergoing off-pump coronary artery bypass surgery (OPCAB group) and who had one or more of the following risks factors: poor left ventricular ejection fraction (EF 30%), significant left main coronary artery stenosis ( 70%), redo surgery, and acute coronary syndrome operated within 48 hours.. Preoperative risk factors, intraoperative variables, and postoperative results were analyzed and compared between the two groups Results: Between June 2006 and November 2008, coronary revascularization was done in 51 high risk patients with average parsonett score 15.4 ±2.8. These patients were divided in 2 groups OPCAB & CABG groups with the demographic profile of the patients and the risk factors were fully matched and balanced. The severity of coronary artery disease was comparable in the two groups, with the incidence of triple vessel disease in OPCAB 70.1% versus 78.2% in CABG (p=0.546). Similarly incidence of left main is the same between 2 groups (p=0.099). . Hospital mortality was 3.3% and 4.5% in the OPCAB and CABG groups, respectively (p = 0.001).The requirement of intraaortic balloon pump postoperatively was also less in the OPCAB(2 patients) versus CABG(5 patients)(p <0.001 group). The incidence of postoperative MI, stroke, renal dysfunction, pulmonary infection, and sternal infection was significantly less in OPCAB group as shown in Table 4. The mechanical ventilation time, blood transfusion requirement was significantly less in OPCAB group. The length of intensive care unit stay & hospital stay were significantly less in the OPCAB group Conclusions: off-pump coronary artery bypass grafting in high-risk patients is safe and is associated with reduced mortality & morbidity in high-risk patients & is also cost effective, when compared with conventional on-pump coronary artery revascularization.