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Ann Thorac Surg 2001;72:768-774
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

One-stage coronary and abdominal aortic operation with or without cardiopulmonary bypass: early and midterm follow-up

Raimondo Ascione, MDa, Gabriele Iannelli, MDa, Kelvin H.H. Lim, FRCSa, Hajime Imura, PhDa, Nicola Spampinato, MDa

a Department of Cardiovascular Surgery, University "Federico II" of Naples, Naples, Italy

Accepted for publication April 25, 2001.

Address reprint requests to Dr Ascione, Bristol Heart Institute, Bristol Royal Infirmary, Marlborough St, Bristol BS2 8HW, UK
e-mail: r.ascione{at}bristol.ac.uk

Background. The aim of this study was to compare hospital, early, and late clinical outcomes for patients undergoing one-stage, coronary and abdominal aortic surgical intervention with and without cardiopulmonary bypass.

Methods. From March 1990 to September 1999, 42 consecutive patients underwent combined operations at a single institution. Cardiopulmonary bypass and cardioplegic arrest were used during coronary revascularization in the first 20 patients (on-pump group), and the next 22 patients received the one-stage operations on the beating heart (off-pump group).

Results. Baseline characteristics were similar between groups. Three cardiac-related hospital deaths occurred in the on-pump group and one such death in the off-pump group (p = 0.25). Cardiac-related events, pulmonary complications, inotropic support, blood loss and transfusion requirements, intensive care unit stay, and hospital stay were significantly reduced in the off-pump group (all, p < 0.05). The actuarial survival rates in the on-pump and off-pump groups were 80% and 95%, respectively, at 1 year (p = 0.13) and 75% and 89%, respectively, at 3 years (p = 0.22). Freedom from cardiac-related events at 1-year follow-up was 91% in the off-pump group and 65% in the on-pump group (p < 0.05). No difference in cardiac-related events between groups was observed at 3 years.

Conclusions. Off-pump coronary surgical procedures decrease postoperative complications in high-risk patients undergoing simultaneous coronary and abdominal aortic operations compared with the conventional one-stage procedure. The early benefits achieved with off-pump surgical intervention are not at the expense of the long-term clinical outcome.


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