Off-pump versus on-pump coronary bypass surgery.

BACKGROUND Whether the clinical outcome of off-pump coronary artery bypass graft (OPCABG) surgery is superior to on-pump coronary artery bypass graft (CABG) surgery is still a matter of debate. However with the considerable reduction of mortality associated with CABG surgery in recent years, more subtle outcome indicators such as quality of life (QOL) become more important. The aim of this study was to compare midterm QOL after OPCABG with that after CABG procedures and with an age- and sex-matched standard population. METHODS Quality of life was assessed using the Short-Form 36 Health Survey Questionnaire for 504 consecutive patients after CABG (n = 438) and OPCABG (n = 66) operated on between June 1999 and November 2000 at our institution. RESULTS Except for single-vessel disease, which was more frequent in OPCABG compared with CABG procedures (13.6% versus 6.8%; p <0.01), the preoperative variables were similar. Median EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 3.2 +/- 1.3 in the CABG group compared with 3.0 +/- 0.8 in the OPCABG group (p = not significant). After a mean follow-up of 10.8 +/- 0.5 months physical role function (73.5 +/- 38.3 versus 45.3 +/- 41.6; p <0.01) and emotional role function (75.3 +/- 40.3 versus 61.0 +/- 43.9; p <0.01) were significantly better in OPCABG than in CABG patients. Compared with a standard population, OPCABG patients were significantly impaired in emotional role function and CABG patients in physical and emotional role function. CONCLUSIONS Midterm QOL after myocardial revascularization is fairly well preserved compared with an age- and sex-matched standard population and is superior after OPCABG compared with CABG. Whether this is only due to avoidance of cardiopulmonary bypass remains to be elucidated.