Why the study?
Does off-pump coronary artery bypass improve perioperative outcomes compared to on-pump bypass in patients with significant left main coronary artery stenosis?
Does off-pump coronary artery bypass improve perioperative outcomes compared to on-pump bypass in patients with significant left main coronary artery stenosis?
Off-pump coronary artery bypass is a safe and effective alternative to on-pump bypass for patients with left main coronary artery disease, associated with reduced inotropic and transfusion requirements.
Off-pump CABG was associated with fewer inotropes and transfusions in left main disease; hypothesis-generating and requires RCTs before practice change.
Experience of on- and off-pump coronary artery bypass in 379 patients with significant left main coronary artery stenosis was retrospectively reviewed. Beating-heart operations were performed on 219 patients between January 2001 and October 2007. Their results were compared with 160 who underwent revascularization under cardiopulmonary bypass during the same period. All patients had multivessel grafting via a median sternotomy. Both groups were comparable demographically. Off-pump patients received significantly fewer grafts per patient (3.21 +/- 0.86 vs 3.74 +/- 0.82). The use of moderate or high doses of inotropics (> 5 microg kg(-1) min(-1)) was more frequent in the on-pump group (44% vs 26%). Postoperative blood transfusion requirement was lower in off-pump patients, and fewer of them experienced worsening of preexisting renal insufficiency. There were 2 operative deaths in the on-pump group and 1 in the off-pump group. The off-pump procedure is safe and effective in patients with left main coronary artery disease.
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Mannam et al. (2008) studied this question.
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