Off-pump versus on-pump coronary artery bypass surgery in patients with triple-vessel disease and enlarged ventricles

BACKGROUND AND OBJECTIVES: Off-pump coronary artery bypass grafting (OPCAB) is a popular treatment for patients with ischemic heart disease, especially for high-risk patients. However, whether OPCAB can lead to better clinical outcomes than on-pump coronary artery bypass grafting (ONCAB) in patients with enlarged ventricles remains controversial. This prospective randomized study was designed to characterize comparison of early clinical outcome and mid-term follow-up following ONCAB versus OPCAB in patients with triple-vessel disease and enlarged ventricles. DESIGN AND SETTINGS: Prospective randomized trial of patients treated at The First Affiliated Hospital, China Medical University, over a 3-year period (2007–2010). METHODS: A total of 102 patients with triple-vessel disease and enlarged ventricles (end-diastolic dimension ≥6.0 cm) were randomized to OPCAB or ONCAB between July 2007 and December 2010. The in-hospital outcomes were analyzed. The study included a mid-term follow-up, with a mean follow-up time of 49.40 (12.88 months). RESULTS: No significant differences were recorded in the baseline clinical characteristics of ONCAB and OPCAB groups. A statistical difference was found between the two groups at the time of extubation, intensive care unit stay, hospital stay, blood requirements, incidence of intra-aortic balloon pump support, pulmonary complications, stroke, reoperation for bleeding, and inotropic requirements >24 hours (P<.05). The number of anastomoses performed per patient, the incidence of postoperative ventricular arrhythmia, myocardial infarction, new-onset atrial fibrillation, hemodialysis, infective complications, recurrent angina, and percutaneous reintervention were similar between the 2 groups (P>.05). The left ventricular end-diastolic dimension was significantly smaller at 6 months’ follow-up in the 2 groups than it was before operation (<.05). No differences in hospital mortality and mid-term mortality between OPCAB and ONCAB groups were found. During the follow-up, no patient in either group had undergone repeat coronary artery bypass grafting. CONCLUSION: No differences in early and mid-term mortality were found between OPCAB and ONCAB in patients with triple-vessel disease and enlarged ventricles. However, OPCAB seems to have a beneficial effect on postoperative complications.