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The Annals of Thoracic Surgery, Vol 54, 1085-1091, Copyright © 1992 by The Society of Thoracic Surgeons
AJ Pfister, MS Zaki, JM Garcia, LA Mispireta, PJ Corso, AG Qazi, SW Boyce, TR Coughlin Jr and P Gurny
The purpose of this article is twofold: to describe our technique for
performing coronary artery bypass grafting without cardiopulmonary bypass
(off pump) and to demonstrate that this operation is safe, in terms of
mortality and certain indices of morbidity. Very little has been published
in regard to off-bypass operations. From 1985 through 1990, 220 patients
underwent operation off bypass; 220 on-pump controls were retrospectively
matched for number of grafts, left ventricular function, and date of
operation. Groups were compared in terms of mortality and ten indicators of
morbidity. The same analysis was performed for ten subgroups. We found no
statistically significant difference between groups in mortality (off pump,
1.4% [3/220]; on pump, 2.4% [5/220]), which held across all subgroups.
Patients undergoing operation off pump required blood far less often (not
transfused: off pump, 72.7% [160/220]; on pump, 54.6% [116/220]; p = 0.005
by Fisher's exact test), and the low output state occurred statistically
less frequently off pump (off pump, 5.5% [12/220]; on- pump, 12.7%
[28/220]; p = 0.01 by Fisher's exact test). Further research should be
directed to which subgroups can be operated on to advantage off pump and
which, if any, groups of patients should be confined to on-bypass
operations.
ARTICLES
Coronary artery bypass without cardiopulmonary bypass
Washington Hospital Center, DC 20009.
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