International Society For Minimally Invasive Cardiothoracic Surgery

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Is There A Benefit In The Long-term Macce Results After Opcab Revascularization? A Retrospective Study In Over 3000 Patients
Marc Albert, Stefan Reichert, Adrian Ursulescu, Ulrich FW Franke.
Robert-Bosch-Hospital, Stuttgart, Germany.

Off-pump myocardial revascularization allows improved short-term results of coronary surgery regarding mortality and neurological outcome. Still, there is limited data about the long-term MACCE results in large cohort studies with long-term follow-up. This study demonstrates those results of more than 3000 patients.
Methods:Between 2006 and 2012 5915 patients received an isolated CABG procedure in our department. We excluded all patients receiving an emergency or re-do procedure and patients operated via left-sided mini-thoracotomy. Of the remaining 3217 patients, 2337 were operated off-pump, 880 on-pump. All patients were interviewed regarding survival, repeat revascularization, recurrence of angina and MACCE rate.
The perioperative data did not differ between the two groups. During the long-term follow up a significant advantage for the OPCAB-technique was found regarding cerebrovascular stroke and survival (see Tab. 1).
Although the OPCAB-technique is described as more demanding for the surgeon compared to the on-pump revascularization, patients operated off-pump show a significant benefit regarding long-term survival and interestingly late-onset of cerebrovascular stroke.

Tab. 1
Off-Pump (n=2337)On-Pump (n=880)p-Value
Recurrence of Angina [n]334 (14.3%)137 (15.6%)0.36
Late Myocardial Infarction49 (2.1%)25 (2.8%)0.17
Late Cerebrovascular Stroke75 (3.2%)43 (4.9%)0.02
Repeat Revascularization21 (0.9%)10 (1.1%)0.61
Long-Term, All-Cause Mortality171 (7.3%)128 (14.6%)0.001

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