Early Results in Isolated Redo Coronary Artery Bypass Grafting: Off Pump versus on Pump Technique

Objectives: Patients undergoing redo-coronary artery bypass surgery (redo-CABG) are often characterized by a critical health status as well as a high incidence of complex coronary pathologies. Therefore, these patients are expected to profit from off-pump coronary surgery (OPCAB). However, the feasibility and superiority of OPCAB for redo-CABG remains still an open issue.

Methods: Between January 2006 and June 2015, from a total of 8441 patients with isolated CABG, of these 304 (3.6%; mean age 69.8 years.; female gender 16.1%) underwent a redo procedure. 179 patients (59%) were operated on with (ONCAB group) and 125 (41%) without (OPCAB group) the use of ECC. For evaluation of independent risk factors for the occurrence of major adverse cardiac and cerebral events (MACCE) a logistic regression analysis was used. There were no differences regarding demographic parameters, LV-EF, co-morbidities, incidence of acute myocardial infarction (AMI) and cardiogenic shock, or for the urgency of operation between the groups.

Results: The rate of total arterial revascularization was higher in the OPCAB group (68% versus 27%, p< 0.001), whereas patients in the ONCAB group had a higher number of distal anastomoses (1.91 versus 2.38, p< 0.001). Patients in the OPCAB group had a significantly lower 30-day mortality rate (0.8 versus 10.6%, p< 0.001), as well as lower rate of renal replacement therapy after surgery (1.6% versus 9.5%, p = 0.005).

Conclusions: In this retrospective single center study the OPCAB technique led to a significant reduction of early mortality and morbidity.