Cardiovascular Journal of Africa: Vol 28 No 1 (January/February 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 1, January/February 2017 30 AFRICA
A comparison of off- and on-pump beating-heart coronary
artery bypass surgery on long-term cardiovascular events
Orcun Gurbuz, Gencehan Kumtepe, Atıf Yolgosteren, Hakan Ozkan, Ilker Hasan Karal, Abdulkadir Ercan,
Serdar Ener
Abstract
Objective: Our aim was to compare short-term outcomes and
long-term major adverse cardiovascular event (MACE)-free
survival and independent predictors of long-term MACE
after off-pump (OPCAB) versus on-pump beating-heart
(ONBHCAB) coronary artery bypass grafting (CABG).
Methods: We retrospectively reviewed data of all consecu-
tive patients who underwent elective CABG, performed by
the same surgeon, from January 2003 to October 2009. A
propensity score analysis was carried out to adjust for base-
line characteristics and a total of 398 patients were included:
ONBHCAB (n = 181), OPCAB (n = 217).
Results: OPCAB was associated with significantly shorter
ventilation times (p < 0.001), intensive care unit stay (p <
0.001) and hospital stay (p < 0.001). The total blood loss was
significantly more in the ONBHCAB group ( p < 0.001), and
accordingly, the number of transfused blood units was signifi-
cantly lower in the OPCAB group ( p < 0.001). Incidence of
peri-operative renal complications were significantly higher
in the ONBHCAB group (p = 0.004). The OPCAB group
showed significantly lower long-term MACE-free survival (p
= 0.029). The mean number of transfused blood units was the
only independent predictor of MACE (HR: 1.218, 95% CI:
1.089–1.361; p = 0.001).
Conclusion: OPCAB provided better long-term MACE-free
survival compared with ONBHCAB. Fewer units of blood
transfused following OPCAB surgery may have been the main
reason for this result.
Keywords: major cardiovascular event, off-pump coronary artery
bypass grafting, on-pump beating heart
Submitted 7/1/16, accepted 5/4/16
Published online 11/5/16
Cardiovasc J Afr 2017; 28: 30–35
DOI: 10.5830/CVJA-2016-049
The adverse effects of cardiopulmonary bypass (CPB), aortic
cross-clamping and cardioplegic arrest have brought about
growing interest in off-pump coronary artery bypass surgery
(OPCAB) since the mid 1990s, as a strategy to protect high-risk
patients from complications.1 Although OPCAB has advantages,2
it also carries some risks, such as intra-operative low cardiac
output and inadequate revascularisation. 3,4 Therefore, the debate
over the optimal method of revascularisation continues.
In recent years, as an alternative to both techniques, the
on-pump beating-heart coronary artery bypass grafting
(ONBHCAB) technique has gained acceptance in order to
eliminate the harmful effects of cross-clamping, cardioplegia and
unloading the heart, and it preserves both native coronary blood
flow and cardiac output during surgery.5-7 Although a meta-
analysis revealed better short-term outcomes and late survival
rates following ONBHCAB compared with conventional CABG
(CCAB),7 studies comparing the outcomes of ONBHCAB and
OPCAB techniques in a similar patient population are lacking.
Therefore we aimed to compare the short-term outcomes
and long-term major adverse cardiovascular event (MACE)-
free survival after ONBHCAB versus OPCAB in a matched
population.
Methods
The research was conducted according to the principles of the
Declaration of Helsinki, and ethical approval was granted by
the local research ethics committee. In this retrospective study,
we reviewed data for all patients who underwent isolated first-
time elective coronary bypass surgery at Uludag University
Faculty of Medicine Hospital and Bursa Medical Park Hospital
between January 2003 and October 2009. The same surgeon
performed the ONBHCAB and OPCAB techniques. There were
no described selection criteria between the two techniques.
Exclusion criteria were as follows: critical pre-operative
state [need for inotropic drug support or intra-aortic balloon
pumping (IABP), acute renal failure, requiring respiratory
support, history of cardiopulmonary resuscitation in the
pre-operative period], myocardial infarction (MI) within three
weeks [cardiac troponin I (cTnI) > 0.01 ng/ml], patients who
underwent single-vessel CABG, and cases that were converted
from OPCAB to ONBHCAB (12 of 339 cases, 3.5%) or
ONBHCAB to conventional CABG [10 of 443 cases (2.2%)]
intra-operatively.
Department of Cardiovascular Surgery, Faculty of
Medicine, Balikesir University, Balikesir, Turkey
Orcun Gurbuz, MD,
Gencehan Kumtepe, MD
Abdulkadir Ercan, MD
Department of Cardiovascular Surgery, Faculty of
Medicine, Uludag University, Bursa, Turkey
Atıf Yolgosteren, MD
Department Of Cardiology, Faculty of Medicine,
Bahcesehir University, Istanbul, Turkey
Hakan Ozkan, MD
Department of Cardiovascular Surgery, Samsun Hospital
for Education and Research, Ilkadim, Samsun, Turkey
Ilker Hasan Karal, MD
Department of Cardiovascular Surgery, Doruk Yıldırım
Hospital, Bursa, Turkey
Serdar Ener, MD