Off-pump revascularization of multivessel coronary artery disease has a decreased myocardial infarction rate

BACKGROUND: The advent of new mechanical stabilization devices allows complete coronary artery revascularization on the beating heart without extracorporeal circulation (ECC). OBJECTIVES: To compare retrospectively the short-term outcomes of 40 patients operated without ECC or cardiopulmonary arrest (group 1) with 40 consecutive patients operated with ECC (group 2) by the same surgeon in the period immediately prior to starting the beating-heart technique. RESULTS: The two groups were similar in terms of age (group 1: 64+/-8 vs. group 2: 62+/-10), male/female ratio (group 1: 31/9 vs. group 2: 32/8), presence of unstable angina prior to surgery (group 1: 72.5% vs. group 2: 77.5%), reoperative surgery (group 1: 1.5% vs. group 2: 7.5%), and perioperative risk factors. Group 1 had an average of 2.8+/-0.7 grafts compared to 3.3+/-0.9 grafts in group 2 (P < 0.01). Postoperative myocardial infarction rate (CK-MB > 50 IU) was 12.5% following ECC and 2.5% with the beating-heart technique (P > 0.001). Maximum perioperative CK-MB level was also decreased in group 1 (group 1: 14+/-17 vs. group 2: 46+/-53, P < 0.001). Postoperative arterial lactate dosage (group 1: 3.1+/-1.2 vs. group 2: 3.9+/-1.6, P = 0.02) and a significant increase in creatinine (>50 mM) (group 1: 5% vs. group 2: 18%, P = 0.06) were also decreased less frequent in patients operated on without ECC. A decrease in transfusion needs was also observed (group 1: 40% vs. group 2: 58%). Similar results were obtained for atrial fibrillation, stroke, postoperative use of intra-aortic balloon pumping (IABP), and pulmonary complication rate. CONCLUSIONS: We conclude from our experience with a multivessel coronary disease population, that a decrease in perioperative myocardial infarction and renal damage can be achieved by using the beating-heart technique.