Myocardial Revascularization By Off Pump Coronary Bypass Surgery (OPCABG): A Ten Year Review

BACKGROUND: The use of cardiopulmonary bypass (CPB) may contribute to post-operative complications and organ dysfunction. Off pump coronary artery bypass grafting (OPCABG) avoids the use of CPB and hence is proposed to reduce these complications. We present the results of OPCABG in Northern Ireland over ten years. METHODS: Data was collected retrospectively from 1995 to 2005. Follow-up was done by telephonic questionnaire and from medical records within a closing interval of two months. RESULTS: 324 patients (224 male) underwent OPCABG with a median age of 62 years (range 35 to 79 years). There were 149 patients with CCS class III/IV angina and 48 with NYHA class III/IV. 148 patients had suffered a myocardial infarction in the past. 36 patients had a pre-operative predictive mortality score (EuroSCORE) of >5 and 48 patients had a preoperative LVEF of <30%. 585 bypass grafts were constructed (LAD=260, Diagonal=27, LCX/OM=123, RCA/PDA=103, RCA/PLV=72). Four patients needed to be converted from OPCABG to CPB on table. Another four patients needed re-operation due to graft related problems in the post-operative period and 6 needed post-operative Intra-aortic Balloon Pump (IABP) support. Post-operative complications included 3 TIAs, 1 complete stroke, 9 patients with renal failure and 51 patients developed atrial fibrillation post operatively. There was one peri-operative death due to pulmonary edema. Ninety percent of patients were in CCS angina class I/II and NYHA class I/II post-operatively. Forty one patients developed significant recurrence of angina requiring medical management, with 7 patients needing PCI/stenting. At the time of follow-up (median 5 years, range 3 months to 10 years) 9 patients had died. CONCLUSIONS: Off pump coronary artery bypass (OPCABG) can be achieved with a low mortality and good medium to long term survival. OPCABG is associated with fewer post-op complications and comparable late coronary interventions.