High-risk patients experience substantially more complications after coronary artery bypass grafting (CABG). We hypothesized that these patients are uniquely vulnerable to cardiopulmonary bypass and compared postoperative outcomes between high-risk patients undergoing off-pump CAB (OPCAB) and conventional CABG. Prospective provincial cardiac care registry and retrospective chart data were reviewed for 1,850 consecutive patients at our institution between January 1996 and January 1999. From this, 235 patients, 36 OPCAB and 199 CABG, were identified as high risk (modified Parsonnet score ≥15). Risk factor analysis showed the populations were equivalent in perioperative risk with mean modified Parsonnet scores of 18.1 ± 3.4 (OPCAB) and 18.7 ± 4.2 (CABG) (P = .4). In total, 6% of OPCAB and 4.0% of CABG patients suffered major complications leading to extended hospital/intensive care unit (ICU) stay or death (P ≤ .001). Mean hospital stays were 7.0 ± 4.0 days (OPCAB) and 10.6 ± 10.2 days (CABG) (P ≤ .001). Mean ICU stays were 23.9 ± 9.7 hours (OPCAB) and 64.9 ± 128.3 hours (CABG) (P ≤ .001). Mortality was 0% in the OPCAB group and 6% in the CABG group (P = .2). Multivariate predictors of experiencing a major complication were: use of cardiopulmonary bypass (OR 5.1, 95 Cl 2.1-12.1), age > 80 (OR 2.5, 95 Cl 1.7- 7.5), female (OR 3.0, 95 Cl 1.6-5.4), repeat operation (OR 2.5, 95 Cl.2-5.4), and ejection fraction <40% (OR 2.4, 95 Cl 1.2-4.7). Extracorporeal circulation is the most important predictor of postoperative complications after CABG in high-risk patients. Off-pump surgery substantially reduces morbidity in this group, and further study of the protective effects of this emerging modality are warranted. (C) 2000 by W. B. Saunders Company.
|Original language||English (US)|
|Number of pages||6|
|Journal||Seminars in Cardiothoracic and Vascular Anesthesia|
|State||Published - 2000|
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine