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Off- pump and on- pump CABG by experienced surgeons; excellent contemporary outcomes regardless of use of cardiopulmonary bypass.
Ramachandra Reddy, Amit Pawale, Julie Swain, Farzan Filsoufi, David H. Adams.
Mount Sinai Medical Center, New York, NY, USA.

Off- pump and on- pump CABG by experienced surgeons; excellent contemporary outcomes regardless of use of cardiopulmonary bypass.
Objective
To compare the outcomes of on and off pump coronary artery bypass grafting (CABG) performed by two experienced surgeons (> 15 years of clinical experience) in a single institution, one of whom exclusively intends to perform off-pump and the other on-pump CABG.
Methods
We retrospectively analyzed prospectively collected data of 590 consecutive patients undergoing isolated CABG by two surgeons between 07/2011 and 02/2015; 293 (49%) off-pump procedures performed by surgeon A and 297 (51%) on-pump performed by surgeon B. Off-pump patients were more likely to have diabetes and severe lung disease while on pump patients were more likely to have higher number of previous percutaneous interventions and Syntax score (Table 1). The mean STS score was not different between the two groups. Outcome measures for this study included hospital mortality, major postoperative complications and length of hospital stay.
Results
The mean number of grafts was 3.4 in both groups. The overall hospital mortality was 0.85% (n=5). The mortality was not different between groups (off-pump 1.00% compared to 0.70% on-pump (p=0.6)). When comparing off-pump with on-pump group, the rate of major morbidities was not different; Stroke (1.4% Vs 1.3%, P=0.99), renal
failure (1.7% Vs 0.3%, p=0.1), atrial fibrillation (24% Vs 21%, p= 0.3). Likewise the median length of hospital stay (5 days for each group) was similar.
Conclusion
Excellent results following contemporary CABG can be obtained by experienced surgeons with an operative mortality of less than 1 %. Among experienced surgeons similar outcomes can be expected regardless of cardiopulmonary bypass with respect to completeness of revascularization and morbidity/mortality. Long term studies are required to further confirm these early results.
Table 1
Preoperative characteristics (590 patients)
VariableOff-pump
Total= 293 pts
N (%)
On –pump
Total= 297 pts
N (%)
P Value
Diabetes195 (66.6%)175 (58.9%)0.060
Lung disease Moderate or Severe16 (5.5%)4 (1.3%)0.006
LVEF < 20%8 (2.7%)7 (2.4%)0.770
Previous PCI78 (26.6%)112 (37.7%)0.004
Syntax score
(median)
27.037.8<.001
STS predicted mortality 1.9%1.5%0.057


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