Off-Pump Coronary Artery Bypass Grafting - Perioperative Results and 1-Year Follow-up

Background: Safety and benefits of off-pump coronary artery bypass grafting (OPCAB) are still intensively discussed topics. The aim of this study was to compare the predicted and the observed mortality and stroke rate in a consecutive series of OPCAB patients and to analyse factors influencing the occurrence of adverse events during the first postoperative year. Methods: 149 patients (age 68 [37–85] years, 108 male, 41 female) underwent OPCAB at our institution between 1998 and 2002. Median EuroSCORE and McSPI stroke risk index predictions concerning the perioperative mortality and stroke rate were 5 % (0–17 %) and 2 % (0.2–30 %). In order to obtain follow-up data, hospital medical records were reviewed, patients were contacted by telephone and additional information was collected from primary physicians and cardiologists. Results: Overall mortality was 4.0 % and the overall stroke rate was 0.0 %. Among our patient series we noticed 5.4 % myocardial infarctions, 10.1 % low cardiac output syndromes, and 8.1 % renal failures requiring haemofiltration. In 53 % of our cases, blood transfusions were necessary. Seventy-nine per cent of the patients stayed free from major adverse cardiac and cerebral events (MACCE) during the first postoperative year. A higher risk score for perioperative mortality, revascularization of the circumflex artery territory, the extent of coronary artery revascularization, and the presence of systemic atherosclerotic disease were significant factors influencing the occurrence of MACCE. Conclusions: OPCAB can achieve perioperative results that are better than those predicted by common risk scores. Major adverse events during the first postoperative year primarily occur in high-risk patients, in those with extensive atherosclerotic disease, in patients with extensive revascularization, and in patients undergoing revascularization of the circumflex artery territory.