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Sotiris C. Stamou
Albert J. Pfister
Mercedes K.C. Dullum
Steven W. Boyce
Ammar S. Bafi
Jorge M. Garcia
Paul J. Corso
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Ann Thorac Surg 2000;69:1383-1387
© 2000 The Society of Thoracic Surgeons

Original articles: Cardiovascular

Beating heart versus conventional single-vessel reoperative coronary artery bypass

Sotiris C. Stamou, MD, PhDa, Albert J. Pfister, MDa, George Dangas, MDa, Mercedes K.C. Dullum, MDa, Steven W. Boyce, MDa, Ammar S. Bafi, MDa, Jorge M. Garcia, MDa, Paul J. Corso, MDa

a Division of Cardiac Surgery, Department of Surgery, Washington Hospital Center, and MedStar Research Institute, Washington, DC, USA

Address reprint requests to Dr Corso, Division of Cardiac Surgery, Washington Hospital Center, 106 Irving St NW, Suite 316, South Tower, Washington, DC 20010
e-mail: pjc{at}mhg.edu

Background. Reoperative (redo) coronary artery bypass grafting (CABG) with cardiopulmonary bypass (on-pump) is associated with a higher morbidity and mortality than first-time CABG. It is unknown, however, whether CABG without cardiopulmonary bypass (off-pump) may yield an improved clinical outcome over conventional on-pump redo CABG.

Methods. We compared the perioperative outcomes of patients with single-vessel disease who underwent on-pump (n = 41) versus off-pump (n = 91) redo CABG between April 1992 and July 1999. The two groups were similar with respect to baseline characteristics and risk stratification: mean Parsonnet scores were 26 ± 9 for on-pump versus 24 ± 8 for off-pump patients (p = nonsignificant).

Results. On-pump redo patients had a higher rate of postoperative transfusions (58% on-pump versus 27% off-pump, p = 0.001), prolonged ventilatory support (17% on-pump versus 4% off-pump, p = 0.03), and a higher rate of postoperative atrial fibrillation (29% on-pump versus 14% off-pump, p = 0.04). On-pump redo CABG was also associated with prolonged postoperative length of stay (8 ± 4 days on-pump versus 5 ± 2 days off-pump, p < 0.001). In-hospital mortality was significantly higher in on-pump than in off-pump patients (10% versus 1%, p = 0.03).

Conclusions. Single-vessel off-pump redo CABG can be performed safely with a lower operative morbidity and mortality than on-pump CABG and an abbreviated hospital stay compared with conventional on-pump redo CABG.




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