1. Safety and Efficacy of "Off Pump" CABG
Kit V. Arom*, Thomas Flavin, Robert W. Emery, Vibhu R. Kshettry, Rebecca J. Petersen
Cardiac Surgical Associates, P.A.
Minneapolis, Minnesota, USA
BACKGROUND
Evaluate the application of the "off-pump" (OPCAB) procedure relative to safety as measured by operative mortality and cost -driving postoperative complications.
MATERIAL AND METHODS:
Three hundred and fifty OPCAB patients were compared to 3,171 "on pump" patients between 1/1/97-12/31/98. The groups were divided into three preoperative predicted risk categories: low risk (0-2.59%), medium risk (2.6-9.9%), and high risk of
³ 10%. STS NCSD definitions and predicted risk group module were utilized to compare all preoperative, intraoperative, and postoperative variables using univariate analysis.|
|
Stroke N (%) |
New Renal Failure N (%) |
New Atrial Fib N (%) |
Mortality N (%) |
|
|
Low Risk |
On Pump N=2360 |
30 (1.3) |
99 (4.2) |
500 (21.2) |
27 (1.1) |
|
0-2.59 |
Off Pump N=216 |
2 (0.9) |
7 (3.2) |
26 (12.0) |
3 (1.4) |
|
N=2576 |
P -value |
1.0 |
0.499 |
0.001 |
0.736 |
|
Medium Risk |
On Pump N=688 |
29 (4.2) |
71 (10.3) |
187 (27.2) |
45 (6.5) |
|
2.6-9.9 |
Off Pump N=95 |
3 (3.2) |
9 (9.5) |
17 (17.9) |
6 (6.3) |
|
N=783 |
P -value |
0.787 |
0.799 |
0.053 |
0.934 |
|
High Risk |
On Pump N=123 |
6 (4.9) |
26 (21.1) |
34 (27.6) |
35 (28.5) |
|
³ 10 |
Off Pump N=39 |
0 (0) |
1 (2.6) |
7 (17.9) |
3 (7.7) |
|
N=162 |
P -value |
0.337 |
0.006 |
0.225 |
0.008 |
RESULTS
Analysis indicates significance forthe occurrence of new atrial fibrillation in comparing the low risk groups; whereas new renal failure is significant in the high risk group comparison. All other comparisons within groups failed to reach significance for other major morbid events. Survival as a primary safety end point showed significance only within the highest risk group.
CONCLUSION
Safety for OPCAB is assessed through retrospective data review. Longitudinal follow-up of OPCAB patients for survival, reintervention, and quality of life at 6 months and 1 year postoperative to document efficacy and patency rates, compared to "on-pump" procedures, is mandatory. Follow-up is currently in process and will be reported.
