Coronary Artery Surgery with or Without Cardiopulmonary Bypass: Impact on Early Outcome

Abstract

Abstract: During the last 10-15 years, coronary artery surgery without use of cardiopulmonary
bypass has gained popularity. Although worldwide incidence of off-pump surgery has remained
around 15%, retrospective studies have shown that off-surgery reduces the inflammatory
response, mortality and morbidity associated with coronary artery surgery.
Objective: To compare early postoperative outcome in patients undergoing coronary artery
surgery with or without cardiopulmonary bypass.
Methods:Aprospective randomized control trial was conducted in Punjab Institute of Cardiology
Lahore. Two hundred consecutive patients undergoing coronary artery surgery were randomized
in two groups. Group I included 107 patients who underwent coronary artery bypass grafting on
CPB and Group II included 93 patients who underwent coronary artery bypass grafting without
CPB. Critically ill patients with hemodynamic instability, previous cardiac surgery and patients
needing concomitant cardiac procedure were excluded from the study. Incidence of early post
operative (within 30 days) mortality and morbidity (myocardial infarction, bleeding, stroke,
arrhythmias, renal and pulmonary complications and infection) were compared among two
groups.
Results: In group I, 96 (89.71%) patients were male and 11(10.29%) were female. In group II,
81(87.09%) patients were male and 12 (12.91%) were female. There was no significant
difference in age, preoperative ejection fraction and risk factors for coronary artery disease
between two groups. Routine blood tests including Hb, ESR, LFTs, RFTs, Lipid profile, bleeding
profile did not show any significant difference among both groups. There was no significant
difference in 30 days mortality among two groups, 2.8% in CCABG as compared to 4.3% in
OPCAB (p=0.492). No significant difference in incidence of adverse post operative cardiac
outcomes as MI [4 (3.7%) in CCABG vs. 7 (7.5%) in OPCAB], use of intra aortic balloon pump
[2(1.9%) in CCABG vs. 2 (2.2%) in OPCAB] and low cardiac output syndrome [2(1.9%) in CCABG
vs. 1(1.0%) in OPCAB] was found among two groups. No significant difference was observed in
amount of bleeding in both groups. The incidence of pulmonary, renal and neurological
complications was similar in both groups. Data regarding ICU stay (5.07+3.88 in CCABG vs.
4.23+2.11 in OPCAB) and hospital stay (12.8+8.14 in CCABG vs. 11.55+5.83 in OPCAB) showed
insignificant difference.
Conclusion: Our study has not shown superiority of OPCAB over CCABG with regards to early
mortality and morbidity which is consistent with other RCT conducted worldwide. So cautious
approach is needed in widespread adoption of OPCAB.