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Eur J Cardiothorac Surg 2004;26:549-553
© 2004 Elsevier Science NL

Operative mortality after conventional versus coronary revascularization without cardiopulmonary bypass

^a Section of Cardiac Surgery, Washington Hospital Center, 106 Irving Street NW, Suite 316, South Tower, Washington, DC 20010, USA
^b Department of Statistics, MedStar Research Institute, Washington, DC, USA

Received 29 November 2003; received in revised form 10 May 2004; accepted 19 May 2004.

^* Corresponding author. 1201 South Eads Street, Apt 1909, Arlington, VA 22202, USA. Tel.: +1-202-361-2377; fax: +1-703-521-1715
e-mail: cvsisfun{at}hotmail.com
e-mail: paul.j.corso{at}medstar.net

Objective: Off-pump coronary artery bypass (CABG) is a safe revascularization option with comparable or superior results to the conventional on-pump CABG. However, comparative analysis of the type of surgical approach on the mortality rate is largely unknown. This study sought to investigate whether CABG without cardiopulmonary bypass (off-pump CABG) is associated with lower operative mortality than the conventional on-cardiopulmonary bypass (on-pump) approach. Methods: From October 1998 to June 2001, off-pump CABG was performed on 2477 patients and on-pump CABG was performed on 3077 patients. The patients undergoing off-pump CABG were randomly matched to on-pump patients via propensity score. Seventy-four percent of the off-pump CABG patients were matched with on-pump patients via propensity scores. A logistic regression model was used to test the difference in the postoperative mortality rate between off-pump CABG and on-pump CABG, controlling the correlation between matched sets. A multiple logistic regression model predicting the risk of mortality adjusted by risk factors of mortality and operation type was computed. Results: Results from the general estimating equation showed that patients who had on-pump CABG were 1.6 (95% confidence intervals (CI)=1.2–2.0, P<0.01) times more likely to die during the first 30 days after surgery than patients who had off-pump CABG. Independent predictors of 30-day mortality identified from the multiple logistic model included on-pump CABG (versus off-pump CABG), advanced age, female gender, carotid artery disease, chronic renal failure, depressed ejection fraction, reoperative CABG, preoperative intraaortic balloon counterpulsation, and recent myocardial infarction. Conclusion: Excellent clinical results and a lower operative mortality rate can be achieved with the off-pump CABG technique compared with the conventional on-pump approach.

Key Words: Coronary artery bypass • Surgical procedures • Minimally invasive • Cardiopulmonary bypass

Abbreviations: CABG, coronary artery bypass graft • On-pump, CABG, CABG with cardiopulmonary bypass • Off-pump, CABG, CABG without cardiopulmonary bypass • CHF, congestive heart failure • COPD, chronic obstructive pulmonary disease • CVA, cerebrovascular accident • MI, myocardial infarction • IABP, intraaortic balloon counterpulsation • OR, odds ratio • CI, confidence intervals

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