Impact of Off-Pump Coronary Bypass Surgery Experience on Early Postoperative Outcome Results from the E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting)

Background: Off-pump coronary artery bypass surgery (OPCAB) is extremely technical demanding. Therefore, we sought to assess the impact of surgical experience on early operative outcome in patients undergoing OPCAB surgery.

Method: Data from the multicenter E-CABG registry (European Multicenter Study on Coronary Artery Bypass Grafting) conducted between January 2015 and December 2016 at 16 European centers were analyzed. Of 7,352 patients in the E-CABG study, 1,511 patients undergoing OPCAB were included and analyzed retrospectively. We analyzed major complication rates (MACCE: early re-revascularization, stroke, acute kidney injury [AKI] and all causes of death) comparing (1) experienced OPCAB surgeon (cut off: >20 cases per year) (n = 1,180) versus non-experienced (n = 331) and (2) experienced surgeon in high-volume OPCAB center (cut-off: >1/3 OPCAB of total CABG procedures) (n = 998) versus non-high-volume OPCAB center (n = 182).

Results: In the experienced OPCAB surgeon group, we observed more distal anastomoses (2.4 ± 1.1 vs. 2.1 ± 1.2; p < 0.001) with shorter procedure time (median 205 vs. 245; p < 0.001), a reduction of prolonged inotrope (18 vs. 29%; p < 0.001), and a reduction of the early postoperative percutaneous catheter intervention (PCI) rate (2 vs. 4%; p = 0.033). Furthermore, we observed a trend toward a reduced 30-day mortality (1 vs. 3%; p = 0.091).

In the high-volume OPCAB centers, significant more distal anastomoses (2.5 ± 1.1 vs. 2.0 ± 0.9; p < 0.001) were performed. Furthermore, we observed trends toward lower mortality (0.9 vs. 2.7%; p = 0.051), less early postoperative PCI procedures (1.5 vs. 3.3%; p = 0.090), and less postoperative AKI (2.9 vs. 5.1%; p = 0.070).

Conclusion: Not only surgeon experience but also center experience may play an important role on early surgical outcome after OPCAB surgery.

Publication History

Article published online:
03 February 2022