Comparative Study of On-pump and Off-pump Coronary Bypass Surgery in Patients with Triple Vessel Coronary Artery Disease

Objective: To analyze comparatively the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple vessel coronary artery disease. Material and Methods: Consecutive 300 isolated multiple coronary artery bypass patients entered into off-pump coronary artery bypass (group OPCAB, n=150) or coronary artery bypass with cardiopulmonary bypass (CPB) (group CCABG, n=150). There was no significant difference with regards to the degree of angina, history of myocardial infarction, diabetes and left main stem disease between two groups. The ejection fraction in group OPCAB before surgery was lower than in group CCABG (P<0.01). Group OPCAB had more patients with history of stroke, and abnormal renal function than group CCABG pre-operatively (P<0.01). All patients had coronary bypass surgery through full sternotomy. Group of CCABG underwent the support of CPB but Group OPCAB did not. Single deep pericardial stay suture with a sling snared down was used to help expose the target coronary vessels in group OPCAB, along with the stabilizers and coronary shunts. Medi-Stim Butterfly Flow meter was used to measure the flow of grafts in both groups. Results: No one in group OPCAB needed to be converted into CCABG. The mean number of the distal anastomosis and the ICR (index of completeness of revascularization) were similar in both groups. The respiratory support time, the chest tube drainage and blood transfusion were less in group OPCAB than in group CCABG post-operatively ( both P<0.01); Pulmonary dysfunction and abnormal renal function were less common in group OPCAB than in group CCABG post-operatively (both P<0.05). There was no significant difference in the mortality and other morbidities (peri-operative MI, stroke, atrial fibrillation). Conclusion: OPCAB can be applied to patients with triple coronary vessels coronary artery disease and achieve similar completeness of revascularization, similar early surgical results with shorter respiratory support, reduced transfusion requirement, less pulmonary dysfunction and less abnormal renal function, as compared to patients undergoing CCABG.