Cardiovascular Journal of Africa: Vol 31 No 1 (January/February 2020)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 1, January/February 2020

AFRICA

can be seen. With 10 mortalities among our cases, we compared

596 patients. The paired-samples

-test was performed between

these two groups and a statistically significant difference was

found (

0.01).

Discussion

In the treatment of coronary artery disease, which is one of

the major causes of death worldwide, CABG surgery plays

an important role. CABG surgeries are often performed with

CPB and most of the time this technique is the major part of

residency training.

CPB provides great support to the surgeon

during distal anastomoses and in the positioning of the heart.

Performing an anastomosis on the beating heart is one of

the biggest drawbacks in the OPCAB approach. However,

OPCAB is an important surgical technique that can be used for

prevention of the side effects of cannulation and CPB.

Although there are more than 100 randomised studies and 60

meta-analyses in which comparison of these two techniques were

made, there was no clear superiority of one technique over the

other. However the experience of the surgeon was emphasised

in all reports.

When chosen routinely, OPCAB surgery can be

as effective as on-pump bypass surgery.

In meta-analyses of

randomised studies, one to two years’ follow up of low-risk

patients showed similar mortality rates, myocardial infarction and

need for repeat revascularisation to on-pump surgery.

9,10

Experience

of the surgeons participating in the studies increased the success

of OPCAB and no significant difference was found between the

patients operated with on- and off-pump techniques.

5,11

The impact of the surgeon’s experience in OPCAB success

was most strikingly demonstrated in the ROOBY study.

The

five-year follow up of patients showed a clear superiority of

ONCAB over OPCAB (operated on by a minimum of 20

experienced OPCAB surgeons). In the light of these studies and

with our dedicated surgical team led by an experienced OPCAB

surgeon, OPCAB surgery has became our routine choice for

CABG operations.

In Table 2, the morbidities experienced in the postoperative

period are shown. We compared our postoperative atrial

fibrillation, intra-operative balloon pump (IABP) insertion,

cerebrovascular events and postoperative revision numbers with

those of the study by Taggart

et al

with 618 patients in the

OPCAB single mammary artery group, and those of the study

by Benedetto

et al

While the number of patients with IABP was

similar, the number of cerebrovascular events and revisions was

fewer in our study.

One of the major advantages of the OPCAB technique

compared to ONCAB is the reduced manipulation of large

vessels. During cannulation, embolisation of atheromatous

plaque from the aorta, bleeding, iatrogenic dissection and

end-organ malperfusion may develop. In addition, cross-

clamping can cause injury to the aorta, which can be avoided

with the OPCAB technique. However, the risk of CVI is not

reduced in OPCAB. The main reason for this is the side-clamp

Table 1. Baseline characteristics of the patients

Variables

(%) or mean

Female

132 (21.8)

Male

474 (78.2)

Age (years)

62.25

9.47

Body mass index (kg/m

)

29.58

4.98

Recent myocardial infarction

Yes

362 (59.7)

244 (40.3)

Diabetes mellitus

Yes

329 (54.3)

277 (45.7)

Hypertension

Yes

323 (53.3)

283 (46.7)

Chronic obstructive pulmonary disease

Yes

398 (65.7)

208 (34.3)

Smoking history

Yes

323 (53.3)

283 (46.7)

Renal disease

No renal disease

580 (95.7)

Dialysis dependent

6 (1)

Creatinine > 2.3 mg/dl

20 (3.3)

Ejection fraction

35%

61 (10.1)

35–50%

285 (47.0)

> 50%

260 (42.9)

Table 2. Postoperative findings

Variables

Mean (min–max) or

(%)

Intubation (hours)

6.31 (1–240)

ICU stay (days)

1.22 (0.04–18.75)

Hospital stay (days)

5.62 (3–48)

Intra-aortic balloon pump

Yes

29 (4.8)

577 (95.2)

Inotropes

None

489 (80.7)

Dopamine

84 (13.9)

Dopamine + noradrenaline

33 (5.4)

Drainage (ml), mean

683.58

193.52

Revision

Yes

5 (0.8)

601 (99.2)

Postoperative atrial fibrillation

Yes

36 (5.9)

570 (94.1)

Cerebrovascular incident

Yes

2 (0.3)

604 (99.7)

Table 3. Number of distal anastomosis

Number of vessels

(%)

1 vessel

48 (7.9)

2 vessels

232 (38.3)

3 vessels

223 (36.8)

4 or more vessels

103 (17.0)

Table 4. Results of pre- and six-month postoperative LVEF comparison

Paired-samples statistics

Variable

Mean (

)

Pre-operative

50.43 (593)

9.36

Postoperative

51.01 (593)

8.67

0.01.