Surgeons' Experience in Off-Pump Coronary Artery Bypass Grafting: Is There a Difference in the Acute 30-Day Outcome

Objectives: Off-pump coronary artery bypass grafting (OPCAB) is considered to be more technically demanding compared with conventional on-pump coronary artery bypass surgery. OPCAB is an established therapy for coronary artery disease in the elderly with or without severely calcified aorta. To date, no reports exist documenting acute outcomes of OPCAB related to different stages of surgeons' experience.

Methods: From 2010 to 2015, 1049 consecutive patients (77.7% male, 69.9 ± 9.8 years, log EuroSCORE II 2.9 ± 3.6%) received OPCAB at our center. Surgeons' experience was retrospectively evaluated as follows: beginner (< 50 OPCAB procedures); trained (≥ 50 OPCAB procedures); skilled (performing OPCAB on a daily basis). Acute 30-day outcomes were retrospectively analyzed and correlated to experience levels.

Results: 70.3% of all patients presented for elective surgery 11.1% were emergency cases, 18.6% urgent. Overall 30-day mortality was 1.7% (18/1432 patients.) in all patients. 30-day mortality presented no significant differences related to surgeons' experience. Beginner surgeons presented OR of 1.7 (CI: 0.8–3.4; p = 0.13) compared with skilled surgeons for 30-day mortality. Trained surgeons showed OR of 1.9 (CI: 0.9–3.8; p = 0.07) compared with skilled surgeons. While skilled surgeons showed no changes in mortality with increasing age, beginner surgeons presented impaired outcomes in the elderly represented by an OR of 2.184 (CI: 1.127–4.421, p = 0.027) for mortality for every 1.5 years of age increase.

Conclusion: OPCAB procedures can be performed safely by beginner and trained surgeons under supervision with comparable acute outcomes compared with skilled surgeons. Patient selection regarding age is of crucial importance to further improve outcomes.