Objective. To analyze the efficacy of revascularization and immediate outcomes of on-pump and off-pump coronary artery bypass grafting (CABG) using microsurgical techniques and microscope. Material and methods. A single-center retrospective study included 534 patients who underwent CABG using microsurgical techniques and microscope between 2014 and 2024: group 1 (off-pump, n=100) and group 2 (control, on-pump, n=434). Propensity score matching (PSM) was applied to balance both groups for 19 parameters (89 pairs). The primary endpoint was efficacy of revascularization (patency of all grafts). Secondary endpoints included in-hospital and 30-day mortality, myocardial infarction, stroke, repeat revascularization; specific complications (acute kidney injury, atrial fibrillation, etc.); and surrogate markers. Results. Revascularization efficacy was comparable between groups before (85% vs. 83.2%, p=0.765) and after PSM (86.5% vs. 84.3%, p=0.832). Omission of cardiopulmonary bypass did not affect this outcome (OR after PSM: 1.20; 95% CI 0.52—2.76, p=0.671). There were no significant differences in rates of in-hospital/30-day mortality, myocardial infarction, stroke, or repeat revascularization. Before PSM, the off-pump group demonstrated significant advantages: lower incidence of acute kidney injury (AKI) (p=0.001) and atrial fibrillation (AF) (p=0.036), shorter ventilation time (p=0.008), less need for red blood cell transfusion (p=0.013), higher hematocrit (p=0.005) and glomerular filtration rate (GFR) (p<0.001), lower creatine kinase-MB (CK-MB) (p<0.001) and shorter hospital stay (p<0.001). After PSM (89 pairs), the advantages of the off-pump group persisted for key indicators: shorter ventilation (p=0.011), lower CK-MB (p<0.001), higher GFR (p=0.010), as well as a lower incidence of AKI (p=0.031) and AF (p=0.047). Conclusion. In CABG with microsurgical technique and microscope, omission of cardiopulmonary bypass does not compromise revascularization efficacy. Moreover, it is associated with more favorable early postoperative course.
Semchenko et al. (Thu,) studied this question.