Off pump coronary artery surgery and intraoperative safety-experience at AFIC/NIHD, Rawalpindi.

BACKGROUND

Coronary Artery Bypass Grafting (CABG) with cardiopulmonary bypass (CPB) on one hand allows controlled haemodynamics with superior graft quality while on the other hand carries inherent risks of CPB which has renewed interest in Off-pump coronary artery bypass (OPCAB). Haemodynamic instability and intraoperative dysrythmias are major procedural complications of OPCAB, threatening conversion to emergency on-pump surgery. The purpose of this study was to compare intraoperative dysrythmias and inotropic use for haemodynamic stabilization during OPCAB surgery against conventional CABG.

METHODS

Consecutive CABG cases operated between 1st June 2003 and 31st May 2006 were included while conversions were excluded. Primary end points were analyzed using chi square and t test and values described in percentages, means and probability (p value).

RESULTS

Six hundred and eighty-four cases were divided in group-A (on-pump, n = 574) and B (OPCAB, n = 97). Conversion rate was 11.8%. Intraoperative dysrythmias (A, 3.5%, B, 15%, p < 0.0001) and use of inotropic support was higher in group-B (A, 15.3%, B, 30.3%, p < 0.0001). Actual mortality in group-B was higher than the predictive value (A, 3.8%, B, 3.6%, Predictive value 3-5% and 0-3% respectively).

CONCLUSION

OPCAB leads to higher frequency of dysrythmias and inotropic use intraoperatively, highlighting lower procedural safety over conventional CABG.