Frontiers in cardiovascular medicine · 2026
OPCAB in the minimally invasive era: impact on wound complications-a comparative study with on-pump CABG.
СтатьяНазвание и аннотация: Перевод в очереди
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Nakamura Ken, Akabane Kentaro, Arai Shusuke, Katsura Ryota, Konaka Miku, Hayashi Jun, Ohba Eiichi, Kim Cholsu, Uchino Hideaki, Shimanuki Takao, Uchida Tetsuro
Аннотация
BACKGROUND: The impact of off-pump coronary artery bypass grafting (OPCAB) on great saphenous vein (GSV) harvest-site wound complications and graft integrity remains uncertain in the contemporary era. We compared harvest-site morbidity, early angiographic outcomes, and long-term clinical events between OPCAB and conventional on-pump coronary artery bypass grafting (CABG).
METHODS: This single-center retrospective study included 394 patients who underwent isolated CABG with available pre- and postoperative coronary angiography between 2005 and 2017. Propensity score matching according to pump usage yielded 157 matched pairs [on-pump CABG, n = 157; OPCAB, n = 157]. The primary endpoint was GSV harvest-site wound complications. Secondary endpoints included early graft occlusion or saphenous vein graft (SVG) stenosis, reintervention, perioperative outcomes, and major adverse cardiac and cerebrovascular events (MACCE).
RESULTS: After matching, baseline characteristics were comparable, although the on-pump group had more distal anastomoses. Leg wound complications were rare and similar between groups (1.3% vs. 0.6%, p = 1.00). Early graft occlusion (9.6% vs. 10.3%, p = 0.553) and SVG occlusion (5.7% vs. 4.5%, p = 0.798) did not differ significantly. SVG stenosis severity and reintervention rates were comparable. OPCAB was associated with shorter operative time, fewer red blood cell transfusions (49.7% vs. 64.3%, p = 0.012), shorter intensive care unit stay, and reduced hospital stay. Thirty-day mortality and 12-month MACCE rates (12.1% in both groups) were similar. Long-term MACCE-free survival up to 10 years showed no significant difference.
CONCLUSION: OPCAB did not reduce GSV harvest-site complications compared with on-pump CABG. Early graft integrity and long-term clinical outcomes were comparable, although OPCAB improved perioperative resource utilization.
METHODS: This single-center retrospective study included 394 patients who underwent isolated CABG with available pre- and postoperative coronary angiography between 2005 and 2017. Propensity score matching according to pump usage yielded 157 matched pairs [on-pump CABG, n = 157; OPCAB, n = 157]. The primary endpoint was GSV harvest-site wound complications. Secondary endpoints included early graft occlusion or saphenous vein graft (SVG) stenosis, reintervention, perioperative outcomes, and major adverse cardiac and cerebrovascular events (MACCE).
RESULTS: After matching, baseline characteristics were comparable, although the on-pump group had more distal anastomoses. Leg wound complications were rare and similar between groups (1.3% vs. 0.6%, p = 1.00). Early graft occlusion (9.6% vs. 10.3%, p = 0.553) and SVG occlusion (5.7% vs. 4.5%, p = 0.798) did not differ significantly. SVG stenosis severity and reintervention rates were comparable. OPCAB was associated with shorter operative time, fewer red blood cell transfusions (49.7% vs. 64.3%, p = 0.012), shorter intensive care unit stay, and reduced hospital stay. Thirty-day mortality and 12-month MACCE rates (12.1% in both groups) were similar. Long-term MACCE-free survival up to 10 years showed no significant difference.
CONCLUSION: OPCAB did not reduce GSV harvest-site complications compared with on-pump CABG. Early graft integrity and long-term clinical outcomes were comparable, although OPCAB improved perioperative resource utilization.