ABSTRACT 70

Off-Pump Coronary Artery Bypass Grafting Significantly Decreases Mortality and Morbidity Risk in High-Risk Patients.

Hartmuth B. Bittner, Michael A Savitt, Kangxiong Liao, Terrance Horrigan, Soon J Park, R   Morton Bolman, University of Minnesota, Division of Cardiothoracic Surgery, Minneapolis MN.

The ideal indication for off-pump coronary artery bypass grafting (OPCABG) has yet to be defined. The purpose of this study is to determine whether OPCABG decreases 30-day operative morbidity and mortality in patients presenting with multivessel coronary artery disease and significant surgical risk factors.

METHODS: Utilizing the STS National Adult Cardiac Surgery Database and a Parsonnet risk stratification model we analyzed the over 12 months prospectively collected University Hospital CABG data. OPCABG was used in 55 patients who are considered high-risk for on-pump CABG because of co-morbidity such as CVA, renal dysfunction/failure, severe COPD, age >75 years, severe cerebro- and peripheral vascular disease, aortic atherosclerosis, EF<35%, religious conviction that precludes blood transfusions, and/or a combination of these risk factors (Tabel 1). Forty-nine patients of the same surgeon underwent on-pump CABG.

RESULTS: The conversion rate to on-pump CABG was 10%. The mortality rate was 0%. Morbidity included one infarction and one take-back for ant wall ischemia and revision of LIMA to LAD anastomosis. Two patients in the on-pump group were converted to   OPCABG intra-op due to severe Porcelain aorta. The mortality rate in the on-pump CABG was 6% (right heart and liver failure 1 patient 1, coagulopathy, 1 intestinal ischemic necrosis). On-pump CABG complications included 2 take-backs for bleeding, acute lower extremity ischemia, and 1 minor CVA.

CONCLUSION: Despite its application to sicker, older, and higher-risk patients OPCABG seems to be associated with a significant decrease in mortality/morbidity following multivessel coronary revascularization. OPCA-BG and beating heart technology may therefore be superior to on-pump CABG in selected patients.