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Ann Thorac Surg 2002;74:115-118
© 2002 The Society of Thoracic Surgeons

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Original article: cardiovascular

Off-pump coronary artery bypass grafting decreases morbidity and mortality in a selected group of high-risk patients

^a Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
^b Albert Starr Academic Center, Providence St. Vincent Heart Institute and Medical Center, Portland, Oregon, USA

Accepted for publication March 28, 2002.

* Address reprint requests to Dr Bittner, University of Minnesota, Division of Cardiothoracic Surgery, Department of Surgery, Box 207, 420 Delaware St, Minneapolis, MN 55455, USA
e-mail: bittn006{at}tc.umn.edu

Background. The ideal indication for off-pump coronary artery bypass grafting (OPCABG) has yet to be defined. High-risk surgical patients may benefit the most when cardiopulmonary bypass (CPB), aortic cross clamping, and cardioplegic arrest are avoided. The aim of this study was to determine whether off-pump coronary artery bypass grafting might decrease the operative morbidity and mortality in a select group of high-risk patients with multivessel coronary artery disease.

Methods. Utilizing a Parsonnet risk stratification model we analyzed prospectively collected data on a cohort of high-risk coronary artery disease patients, which were operated on with beating-heart technology by the same group of surgeons in a tertiary care university medical center. High-risk patients were defined as those with a Parsonnet score of 15 or greater.

Results. Fifty-seven multivessel disease OPCABG patients (over a period of 2 years) had markedly increased Parsonnet scores (24.3 ± 10.6). The average ejection fraction of the patients was 42% (±12.3) and their age ranged from 52 to 85 years (mean 70.6 ± 10.4, 26% women). Unstable angina was present in 42 patients (74%) and 10 patients underwent OPCABG within 24 hours of the occurrence of acute myocardial infarction. In addition to severe coronary artery disease 32% of the patients presented with congestive heart failure, insulin-dependent diabetes (18%), renal failure (22%), peripheral vascular disease (31%), pulmonary disease (18%), and neurologic disorders (14%). An average of 2.6 ± 0.9 grafts/patient were performed and the posterior descending artery or marginal branches of the circumflex artery or both were grafted in 90%. The 30-day mortality rate was 3.5% (n = 2).

Conclusions. OPCABG can be performed with a reasonable low morbidity and mortality in this select group of high-risk patients. OPCABG is a reasonable, and might even be preferable, operative strategy in this high-risk group of patients.

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