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Ann Thorac Surg 2004;77:574-579
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

High risk coronary artery bypass patient: incidence, surgical strategies, and results

^a Department of Cardiac Surgery, Catholic University, Rome, Italy

Accepted for publication August 6, 2003.

^* Address reprint requests to Dr Gaudino, Divisione di Cardiochirurgia, Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy.
e-mail: mgaudino{at}dtiscali.it

BACKGROUND: To describe our experience in the treatment of high risk coronary artery bypass patients and compare patients assigned to on-pump or off-pump surgery.

METHODS: During a 42-month period 306 high risk (Euroscore > 5) coronary artery bypass patients were consecutively treated at our institution. On the basis of the coronary anatomy and possibility of achieving a complete revascularization, 197 patients were assigned to off-pump and 109 to on-pump operation. Overall mortality was 6.2% (19 of 306 patients).

RESULTS: Although patients treated off-pump had a better cardiac status, no clinical advantages related to the avoidance of cardiopulmonary bypass were found in the overall population. Off-pump patients had more early and late cardiac complications, whereas patients operated on-pump exhibited an higher incidence of postoperative systemic organ dysfunction. Off-pump surgery improved in-hospital outcome only in the subset of patients at highest risk.

CONCLUSIONS: Avoidance of cardiopulmonary bypass does not confer significant clinical advantages in all high risk coronary patients; instead, there are particular subsets of patients in whom beating heart surgery can be particularly indicated and others for whom on-pump revascularization appears a better solution. Adaptation of the operation to the single patient is probably the way to improve outcome.

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