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Ann Thorac Surg 2001;71:170-175
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Coronary artery bypass grafting with cardiopulmonary bypass versus off-pump cardiopulmonary bypass grafting: does eliminating the pump reduce morbidity and cost?

David A. Bull, MDa, Leigh A. Neumayer, MDa, James C. Stringham, MDa, Patricia Meldrum, RNa, David G. Affleck, MDa, Shreekanth V. Karwande, MDa

a Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, USA

Address reprint requests to Dr Bull, Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, 50 N. Medical Dr, Salt Lake City, UT 84132
e-mail: david.bull{at}hsc.utah.edu

Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, January 31–Feb 2, 2000.

Background. Cardiopulmonary bypass (CPB) may contribute to the complications and cost of coronary artery bypass grafting (CABG). Off-pump CABG (OPCAB) allows coronary revascularization without CPB. We hypothesized that OPCAB provides satisfactory graft patency while reducing complications and cost compared with CABG with CPB.

Methods. We prospectively followed 80 patients undergoing CABG: 40 patients undergoing OPCAB and 40 patients undergoing CABG with CPB. OPCAB patients underwent angiography within 48 hours of surgery to determine early graft patency. Incidence of complications, length of stay, and costs were recorded for each patient. The influence of the number of vessels bypassed was analyzed.

Results. OPCAB patients (n = 40) underwent grafting of 2.7 ± 0.7 vessels per patient compared with 3.6 ± 0.8 vessels per patient in the CABG with CPB group (n = 40) (p < 0.0001). Angiography demonstrated 105 of 108 (97%) of grafts were patent in the OPCAB group. Incidence of complications, length of stay, and costs did not differ between the OPCAB and CABG with CPB groups. Number of vessels grafted showed a positive correlation to total costs in both groups.

Conclusions. While OPCAB provided satisfactory early graft patency, there was no significant difference between OPCAB and CABG with CPB with regard to cost, length of stay, or incidence of complications. In this study, eliminating CPB did not reduce morbidity or cost after CABG.




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