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Eur J Cardiothorac Surg 2003;23:360-367
© 2003 Elsevier Science NL

Early and late outcome of myocardial revascularization with and without cardiopulmonary bypass in high risk patients (EuroSCORE6)

Department of Cardiology and Cardiac Surgery, University ‘G. D'Annunzio’, S. Camillo de' Lellis Hospital, via C. Forlanini, 50, 66100 Chieti, Italy

Received 9 September 2002; received in revised form 13 November 2002; accepted 27 November 2002.

^* Corresponding author. Tel.: +39-0871-358-653; fax: +39-0871-402-239
e-mail: calafiore{at}unich.it

Objective: To evaluate 30-day and late results in high risk patients (European score (EuroSCORE)6) who underwent isolated myocardial revascularization with and without cardiopulmonary bypass (CPB). Methods: From November 1994 to December 2001, 1266 patients with EuroSCORE6 underwent isolated myocardial revascularization. Among them, applying the propensity score, we were able to select 1020 patients operated on without CPB (group A, n=510) and with CPB (group B, n=510) with the same preoperative characteristics. The only differences were the higher incidence of patients with age between 61 and 65 years (9.4% in group A vs. 13.9% in group B, P=0.025) and the lower number of anastomoses/patient in group A (1.8±0.9 vs. 2.8±0.9, P<0.001). EuroSCORE were identical in both groups (7.8%). Results: Thirty-day mortality was higher in group B (5.9 vs. 3.1%, P=0.035). Group A showed a lower incidence of cerebrovascular accidents (CVAs) (0.6 vs. 3.1%, P=0.003), whereas incidence of acute myocardial infarction (AMI) was similar (2.0% in group A vs. 2.5% in group B, P=ns). Early negative primary end-points and early major events incidences were higher in group B (8.2 vs. 3.9%, P=0.004, and 14.5 vs. 7.1%, P<0.001, respectively). Stepwise logistic regression confirmed that CPB was an independent predictor for higher early mortality (Odds ratio (OR) 2.0) and CVA, negative primary end-points and early major events incidences (OR 4.6, 2.3 and 2.4, respectively). Five-year freedom from the events explored (death due to any cause, cardiac death, AMI, AMI on a grafted area, redo/percutaneous transluminal coronary angioplasty (PTCA), redo/PTCA on a grafted area, target cardiac events (cardiac death, AMI in a grafted area and redo/PTCA in a grafted area) and any event were similar in both groups. Conclusions: In high risk patients myocardial revascularization without CPB shows better early outcome and similar clinical late results.

Key Words: Off pump surgery • High-risk • Myocardial revascularization

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