Off-pump versus on-pump coronary artery bypass surgery in patients with triple-vessel disease and enlarged ventricles

• Published in: Annals of Saudi medicine 2014-05, Vol.34 (3), p.222-228
• Main Authors: Yu, Lei, Gu, Tianxiang, Shi, Enyi, Wang, Chun, Fang, Qin, Yu, Yang, Zhao, Xiaoqi, Qian, Cheng
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty; Body mass index; Cardiac arrhythmia; Cardiovascular disease; China; Chronic obstructive pulmonary disease; Coronary Artery Bypass - methods; Coronary Artery Bypass, Off-Pump - methods; Coronary Artery Disease - physiopathology; Coronary Artery Disease - surgery; Coronary vessels; Diabetes; Female; Follow-Up Studies; Heart failure; Heart surgery; Hospital Mortality; Hospitals; Humans; Hypertension; Length of Stay; Male; Medical prognosis; Middle Aged; Mortality; Original; Patients; Postoperative Complications - epidemiology; Prospective Studies; Standard deviation; Stroke; Time Factors; Treatment Outcome
• ISSN: 0256-4947; 0975-4466
• DOI: 10.5144/0256-4947.2014.222

Off-pump coronary artery bypass grafting (OPCAB) is a popular treatment for patients with ischemic heart disease, especially for high-risk patients. However, whether OPCAB can lead to better clinical outcomes than on-pump coronary artery bypass grafting (ONCAB) in patients with enlarged ventricles remains controversial. This prospective randomized study was designed to characterize comparison of early clinical outcome and mid-term follow-up following ONCAB versus OPCAB in patients with triple-vessel disease and enlarged ventricles. Prospective randomized trial of patients treated at The First Affiliated Hospital, China Medical University, over a 3-year period (2007-2010). A total of 102 patients with triple-vessel disease and enlarged ventricles (end-diastolic dimension >=6.0 cm) were randomized to OPCAB or ONCAB between July 2007 and December 2010. The in-hospital out.comes were analyzed. The study included a mid-term follow-up, with a mean follow-up time of 49.40 (12.88 months). No significant differences were recorded in the baseline clinical characteristics of ONCAB and OPCAB groups. A statistical difference was found between the two groups at the time of extubation, intensive care unit stay, hospital stay, blood requirements, incidence of intra-aortic balloon pump support, pulmonary complications, stroke, reoperation for bleeding, and inotropic requirements > 24 hours (P < .05). The number of anastomoses performed per patient, the incidence of postoperative ventricular arrhythmia, myocardial infarction, new-onset atrial fibrillation, hemodialysis, infective complications, recurrent angina, and percutaneous reintervention were similar between the 2 groups (P > .05). The left ventricular end-diastolic dimension was significantly smaller at 6 months' follow-up in the 2 groups than it was before operation ( < .05). No differences in hospital mortality and mid-term mortality between OPCAB and ONCAB groups were found. During the follow-up, no patient in either group had undergone repeat coronary artery bypass grafting. No differences in early and mid-term mortality were found between OPCAB and ONCAB in patients with triple-vessel disease and enlarged ventricles. However, OPCAB seems to have a beneficial effect on postoperative complications.