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Kit V. Arom
Thomas F. Flavin
Robert W. Emery
Vibhu R. Kshettry
Patricia A. Janey
Rebecca J. Petersen
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Ann Thorac Surg 2000;69:704-710
© 2000 The Society of Thoracic Surgeons

Original Articles

Safety and efficacy of off-pump coronary artery bypass grafting

Kit V. Arom, MD, PhDa, Thomas F. Flavin, MDa, Robert W. Emery, MDa, Vibhu R. Kshettry, MDa, Patricia A. Janey, RNa, Rebecca J. Petersen, RNa

a Cardiac Surgical Associates, PA, Minneapolis, Minnesota, USA

Address reprint requests to Dr Arom, Cardiac Surgical Associates, PA, 920 E 28th St, Suite 420, Minneapolis, MN 55407
e-mail: karom{at}csa-heart.com

Presented at the Forty-sixth Annual Meeting of the Southern Thoracic Surgical Association, San Juan, Puerto Rico, Nov 4–6, 1999.

Background. We evaluated the application of the off-pump coronary artery bypass (OPCAB) procedure relative to safety and efficiency as measured by operative mortality postoperative complications and longitudinal outcome.

Methods. Three hundred and fifty OPCAB patients were compared to 3,171 on-pump or conventional coronary artery bypass (CCAB) patients between January 1, 1997 and December 31, 1998. The groups were divided into three preoperative predicted risk categories: low-risk (0 to 2.59%), medium-risk (2.6 to 9.9%), and high-risk (>=10%). Society of Thoracic Surgeons National Cardiac Surgery Database definitions and predicted risk group models were utilized to compare all preoperative, intraoperative, and postoperative variables using univariate analysis.

Results. Overall comparison of the immediate outcome of CCAB and OPCAB shows little statistical significance in the variables analyzed. The operative mortality was 3.4% in both groups. When the immediate outcome was compared between groups (CCAB vs OPCAB), as well as individual risk groups (low, medium, and high), similar patterns of operative variables and postoperative complications were observed. The operative mortality in the low-risk group was 1.1% for CCAB and 1.4% for OPCAB; 7% for CCAB and 6% for OPCAB in the medium-risk group; and in the high-risk group 28.5% for CCAB compared to 7.7% for OPCAB group (p = 0.008). Short-term follow-up shows a trend of increased recurring angina and reinterventional procedures in the OPCAB patients.

Conclusions. Safety for OPCAB is assessed through retrospective data review. Longitudinal follow-up for survival, reintervention, and quality of postoperative document efficacy and patency rates, compared to on-pump procedures, is mandatory. This study documented the immediate safety of the OPCAB procedure. Preliminary findings at 1-year follow-up is an important finding in this study, but it is not conclusive at this time. Long-term longitudinal follow-up is required to assess the future effectiveness of OPCAB.


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Y. Louagie, J. Jamart, S. Broka, E. Collard, V. Scavee, and M. Gonzalez
Off-pump coronary artery bypass grafting: a case-matched comparison of hemodynamic outcome
Eur. J. Cardiothorac. Surg., October 1, 2002; 22(4): 552 - 558.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. J. Mack and F. G. Duhaylongsod
Through the open door! Where has the ride taken us?
J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 655 - 659.
[Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
J. F. Sabik, A. M. Gillinov, E. H. Blackstone, C. Vacha, P. L. Houghtaling, J. Navia, N. G. Smedira, P. M. McCarthy, D. M. Cosgrove, and B. W. Lytle
Does off-pump coronary surgery reduce morbidity and mortality?
J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 698 - 707.
[Abstract] [Full Text] [PDF]

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 Asian Cardiovasc. Thorac. Ann.Home page
K. V Arom, R. W Emery, T. F Flavin, V. R Kshettry, and P. Janey
Surgical Steps Toward Complete Revascularization in Off-Pump Coronary Bypass
Asian Cardiovasc Thorac Ann, September 1, 2002; 10(3): 201 - 205.
[Abstract] [Full Text] [PDF]

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 HeartHome page
P. P T. de Jaegere and W. J L Suyker
OFF-PUMP CORONARY ARTERY BYPASS SURGERY
Heart, September 1, 2002; 88(3): 313 - 318.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
N. C. Patel, A. P. Deodhar, A. D. Grayson, D. M. Pullan, D. J.M. Keenan, R. Hasan, and B. M. Fabri
Neurological outcomes in coronary surgery: independent effect of avoiding cardiopulmonary bypass
Ann. Thorac. Surg., August 1, 2002; 74(2): 400 - 406.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
V. Falk
Manual control and tracking--a human factor analysis relevant for beating heart surgery
Ann. Thorac. Surg., August 1, 2002; 74(2): 624 - 628.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
X. M. Mueller, P.-G. Chassot, J. Zhou, K. M. Eisa, C. Chappuis, H. T. Tevaearai, and L. K. von Segesser
Hemodynamics optimization during off-pump coronary artery bypass: the 'no compression' technique
Eur. J. Cardiothorac. Surg., August 1, 2002; 22(2): 249 - 254.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
N.C. Patel, A.D. Grayson, M. Jackson, J. Au, N. Yonan, R. Hasan, and B.M. Fabri
The effect off-pump coronary artery bypass surgery on in-hospital mortality and morbidity
Eur. J. Cardiothorac. Surg., August 1, 2002; 22(2): 255 - 260.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
W. Cheng, T. A. Denton, G. P. Fontana, S. Raissi, C. Blanche, R. M. Kass, K. E. Magliato, J. Mirocha, and A. Trento
Off-pump coronary surgery: Effect on early mortality and stroke
J. Thorac. Cardiovasc. Surg., August 1, 2002; 124(2): 313 - 320.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
R. Ascione, K. Rees, K. Santo, M.H. Chamberlain, G. Marchetto, F. Taylor, and G.D. Angelini
Coronary artery bypass grafting in patients over 70 years old: the influence of age and surgical technique on early and mid-term clinical outcomes
Eur. J. Cardiothorac. Surg., July 1, 2002; 22(1): 124 - 128.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. H. Chamberlain, R. Ascione, B. C. Reeves, and G. D. Angelini
Evaluation of the effectiveness of off-pump coronary artery bypass grafting in high-risk patients: an observational study
Ann. Thorac. Surg., June 1, 2002; 73(6): 1866 - 1873.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
T. A. Vassiliades Jr, J. L. Nielsen, and J. L. Lonquist
Hemodynamic collapse during off-pump coronary artery bypass grafting
Ann. Thorac. Surg., June 1, 2002; 73(6): 1874 - 1879.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
N. C. Patel, D. M. Pullan, and B. M. Fabri
'Shunt shuffle'--a simple technique of introducing intracoronary shunts for off-pump coronary artery bypass
Eur. J. Cardiothorac. Surg., June 1, 2002; 21(6): 1121 - 1122.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
N.A. Scott, J.L. Knight, B.P. Bidstrup, H. Wolfenden, R.N. Linacre, and G.J. Maddern
Systematic review of beating heart surgery with the Octopus(R) Tissue Stabilizer
Eur. J. Cardiothorac. Surg., May 1, 2002; 21(5): 804 - 817.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. Yeatman, M. Caputo, P. Narayan, A. Kumar Ghosh, R. Ascione, I. Ryder, and G. D. Angelini
Intracoronary shunts reduce transient intraoperative myocardial dysfunction during off-pump coronary operations
Ann. Thorac. Surg., May 1, 2002; 73(5): 1411 - 1417.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
W. A. Lell, V. G. Nielsen, D. C. McGiffin, F. E. Schmidt Jr, J. K. Kirklin, and A. W. Stanley Jr
Glucose-insulin-potassium infusion for myocardial protection during off-pump coronary artery surgery
Ann. Thorac. Surg., April 1, 2002; 73(4): 1246 - 1251.
[Abstract] [Full Text] [PDF]

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 Crit Care NurseHome page
B. T. Lorenz and K. M. Coyte
Coronary Artery Bypass Graft Surgery Without Cardiopulmonary Bypass: A Review and Nursing Implications
Crit. Care Nurse, February 1, 2002; 22(1): 51 - 60.
[Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
O. Chavanon, M. Durand, R. Hacini, H. Bouvaist, M. Noirclerc, T. Ayad, and D. Blin
Coronary artery bypass grafting with left internal mammary artery and right gastroepiploic artery, with and without bypass
Ann. Thorac. Surg., February 1, 2002; 73(2): 499 - 504.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
M. Murtra
The adventure of cardiac surgery
Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 167 - 180.
[Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
M. Riha, M. Danzmayr, G. Nagele, L. Mueller, D. Hoefer, H. Ott, G. Laufer, and J. Bonatti
Off pump coronary artery bypass grafting in EuroSCORE high and low risk patients
Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 193 - 198.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
S. Muraki, C. D. Morris, J. M. Budde, R. N. Otto, Z.-Q. Zhao, J. D. Puskas, R. A. Guyton, and J. Vinten-Johansen
Preserved myocardial blood flow and oxygen supply-demand balance with active coronary perfusion during simulated off-pump coronary artery bypass grafting
J. Thorac. Cardiovasc. Surg., January 1, 2002; 123(1): 53 - 62.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
P. Menasche
The systemic factor: the comparative roles of cardiopulmonary bypass and off-pump surgery in the genesis of patient injury during and following cardiac surgery
Ann. Thorac. Surg., December 1, 2001; 72(6): S2260 - 2265.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
O. Lund, J. Christensen, S. Holme, K. Fruergaard, A. Olesen, E. Kassis, and U. Abildgaard
On-pump versus off-pump coronary artery bypass: independent risk factors and off-pump graft patency
Eur. J. Cardiothorac. Surg., November 1, 2001; 20(5): 901 - 907.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
F. Hernandez, W. E. Cohn, Y. R. Baribeau, J. F. Tryzelaar, D. C. Charlesworth, R. A. Clough, J. D. Klemperer, J. R. Morton, B. M. Westbrook, E. M. Olmstead, et al.
In-hospital outcomes of off-pump versus on-pump coronary artery bypass procedures: a multicenter experience
Ann. Thorac. Surg., November 1, 2001; 72(5): 1528 - 1534.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
J. C. Cleveland Jr, A. L. W. Shroyer, A. Y. Chen, E. Peterson, and F. L. Grover
Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity
Ann. Thorac. Surg., October 1, 2001; 72(4): 1282 - 1289.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. J. Magee, T. M. Dewey, T. Acuff, J. R. Edgerton, J. F. Hebeler, S. L. Prince, and M. J. Mack
Influence of diabetes on mortality and morbidity: off-pump coronary artery bypass grafting versus coronary artery bypass grafting with cardiopulmonary bypass
Ann. Thorac. Surg., September 1, 2001; 72(3): 776 - 781.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
K. V. Arom, R. W. Emery, T. F. Flavin, V. R. Kshettry, and R. J. Petersen
OPCAB surgery: a critical review of two different categories of pre-operative ejection fraction
Eur. J. Cardiothorac. Surg., September 1, 2001; 20(3): 533 - 537.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
R. J. Novick, S. A. Fox, L. W. Stitt, S. A. Swinamer, K. R. Lehnhardt, R. Rayman, and W. D. Boyd
Cumulative sum failure analysis of a policy change from on-pump to off-pump coronary artery bypass grafting
Ann. Thorac. Surg., September 1, 2001; 72(3): S1016 - 1021.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
A. M. Calafiore, M. Di Mauro, M. Contini, G. Di Giammarco, M. Pano, G. Vitolla, A. Bivona, R. Carella, and S. D'Alessandro
Myocardial revascularization with and without cardiopulmonary bypass in multivessel disease: impact of the strategy on early outcome
Ann. Thorac. Surg., August 1, 2001; 72(2): 456 - 462.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
M. E. Plomondon, J. C. Cleveland Jr, S. T. Ludwig, G. K. Grunwald, C. I. Kiefe, F. L. Grover, and A. L. Shroyer
Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes
Ann. Thorac. Surg., July 1, 2001; 72(1): 114 - 119.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
K.-B. Kim, C. Lim, H. Ahn, and J.-K. Yang
Intraaortic balloon pump therapy facilitates posterior vessel off-pump coronary artery bypass grafting in high-risk patients
Ann. Thorac. Surg., June 1, 2001; 71(6): 1964 - 1968.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
G. Pompilio, M. Zanobini, G. Polvani, F. Alamanni, and P. Bignoli
Efficacy of off-pump coronary artery bypass grafting in high-risk patients
Ann. Thorac. Surg., May 1, 2001; 71(5): 1750 - 1751.
[Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
C. Detter, H. Reichenspurner, D. H. Boehm, M. Thalhammer, A. Schutz, and B. Reichart
Single vessel revascularization with beating heart techniques - minithoracotomy or sternotomy?
Eur. J. Cardiothorac. Surg., April 1, 2001; 19(4): 464 - 470.
[Abstract] [Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
O. Jegaden and P. Mikaeloff
Off-pump coronary artery bypass surgery. The beginning of the end?
Eur. J. Cardiothorac. Surg., March 1, 2001; 19(3): 237 - 238.
[Full Text] [PDF]

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 Eur. J. Cardiothorac. Surg.Home page
M. Yeatman, M. Caputo, R. Ascione, F. Ciulli, and G. D. Angelini
Off-pump coronary artery bypass surgery for critical left main stem disease: safety, efficacy and outcome
Eur. J. Cardiothorac. Surg., March 1, 2001; 19(3): 239 - 244.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
S. Muraki, C. D. Morris, J. M. Budde, D. A. Velez, Z.-Q. Zhao, R. A. Guyton, and J. Vinten-Johansen
Experimental off-pump coronary artery revascularization with adenosine-enhanced reperfusion
J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 570 - 579.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. C. Stamou and P. J. Corso
Coronary revascularization without cardiopulmonary bypass in high-risk patients: a route to the future
Ann. Thorac. Surg., March 1, 2001; 71(3): 1056 - 1061.
[Abstract] [Full Text] [PDF]

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 JAMAHome page
R. Pretre and M. I. Turina
Choice of Revascularization Strategy for Patients With Coronary Artery Disease
JAMA, February 28, 2001; 285(8): 992 - 994.
[Full Text] [PDF]


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