OPCAB Compared with Conventional CABG in Patients Receiving More than One Bypass Graft

Objective: Recent studies report no significant benefit for the operative treatment of coronary heart disease in Off-pump surgery (OPCAB). We compare our patient collective undergoing coronary artery bypass grafting (CABG) during the past 7 years.

Methods: We compared all OPCAB (1,235 patients) and on-pump CBAG (onCABG, 2,381 patients) procedures from 2010 to 2016 receiving more than one distal anastomosis during myocardial revascularization. Patient characteristics, operative procedure and early postoperative results were analyzed in the EQS-database.

Results: During this period, portion of OPCAB increased from 32.4% to 40.4%. Percentage of women was similar in both groups (18.0 vs. 18.7%, onCABG vs. OPCAB, p = 0.61). Patients treated by OPCAB were significantly older (66.1 ± 9.3 vs. 69.7 ± 9.5 years, p < 0.001). The fraction of patients without prior myocardial infarction (59.4 vs. 70.6%, p < 0.001) and EF>50% (30.5 vs. 39.3%, p < 0.001) was significantly higher in the OPCAB group. Also the percentage of vascular disease was significantly increased in this group (15.0 vs. 28.8%, p < 0.001). Percentage of Diabetes mellitus was 31.2 vs. 27.4% (onCABG vs. OPCAB, p = 0.042). Mean OR-time was 245 ± 59 versus 196 ± 50 minutes (onCABG vs. OPCAB, p < 0.001). Type and use of bypass grafts differed significantly. Number of grafts (2.94 ± 0.8 vs. 2.57 ± 0.6, onCABG vs. OPCAB, p < 0.001), distal arterial (1.98 ± 0.9 vs. 1.8 ± 0.9, p < 0.001), distal venous (0.96 ± 1.0 vs. 0.77 ± 0.9, p < 0.001) as well as central anastomoses (0.7 ± 0.7 vs. 0.14 ± 0.4, p < 0.001) were significantly different. Total arterial revascularization rate was 44.1% in onCABG versus 50.7% in the OPCAB group (p < 0.001). Resternotomy rate (5.3 vs. 6.6%, onCABG vs. OPCAB, p = 0.4), postoperative myocardial infarction (1.2 vs. 1.3%, p = 0.7), use of IABP/ECMO (2.8 vs. 1.4%, p = 0.03) and stroke rate (1.5 vs. 0.8%, p = 0.03) were not significantly different. Hospital- (1.7 vs. 1.4%, onCABG vs. OPCAB, p = 0.46) and 30-day-mortality (2.0 vs. 2.7%, %, p = 0.16) did not diverge in-between the groups.

Conclusion: Major adverse cardiac and cerebrovascular event (MACCE) rate in patients with multivessel disease undergoing operative myocardial revascularization showed a tendency to be reduced by use of OPCAB technology. Despite a significantly higher average age in the OPCAB group MACCE rate was comparable. Solely the stroke rate showed a clear trend favoring OPCAB procedure for patients at risk.

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