OFF-PUMP CORONARY BYPASS IN HIGH-RISK PATIENTS. SHORT-TERM RESULTS

Abstract

Introduction: The life expectancy increase is steadily leading to the fact that more and more severe patients
begin to undergo surgical treatment of coronary artery disease. Off-pump coronary artery bypass grafting may be
the operation of choice in treating this category of patients.
Objective: To study the immediate results of surgical treatment of coronary artery disease using Off-pump
myocardial revascularisation in patients with a high risk of mortality and complications.
Materials and Methods: The study summarised the results of surgical treatment of 1339 high-risk patients with
coronary artery disease who were operated on in the period from 2003 to 2015, of which 672 - using the Offpump revascularisation and 667 - using the conventional On-pump CABG with cardio-pulmonary bypass. The
groups were comparable in age: the mean age in the Off-pump group was 69.6 ± 7.4 years, and in the On-pump
group - 69.8 ± 7.7 years (p = 0.874).
Results: In both groups, most often, multivessel coronary artery bypass grafting was performed. In the Offpump group, revascularisation of three or more coronary arteries was performed in 519 (77.3%) patients, and the
On-pump group - in 521 (78.22%); there was no statistical difference (p = 0.699). The mean total duration of
surgery was 5.3 ± 1.6 hours in the Off-pump group and 5.22 ± 1.3 hours in the On-pump group and had no
significant difference (p = 0.3165). The intraoperative need for intra-aortic balloon pump counterpulsation in the
On-pump group was significantly higher than in the Off-pump group (p = 0.0002). A significantly lower (p
<0.05) number of cerebral and renal complications in the postoperative period was revealed in patients
undergoing Off-pump myocardial revascularisation. In the general group of high-risk patients, both groups did
not significantly differ in the frequency of deaths. Thus, in the Off-pump group, the frequency of deaths was
3.4% (23 patients) and in the On-pump group - 5.4% (36 patients) (p = 0.0785). In the On-pump CABG group,
mortality in female patients was higher than in the Off-pump group (p = 0.031).
Conclusions: Based on the data obtained, it was concluded that Off-pump myocardial revascularisation is highly
effective in the surgical treatment of high-risk patients.