Late outcomes of on-pump and off-pump redo coronary artery bypass grafting

Loreta Ivaškevičienė, Giedrė Nogienė, Irena Butkuvienė, Gintaras Kalinauskas, Arūnas Valaika, Jurgis Verižnikovas¹, Giedrius Uždavinys

Center of Cardiac Surgery, Vilnius University, ¹Center of Cardiac Surgery, Vilnius University Hospital Santariškių Klinikos, Lithuania

Key words: coronary artery disease; redo coronary artery bypass grafting; late results.

Summary. Benefits of off-pump surgery are still widely debated in the literature comparing with conventional coronary artery bypass grafting. The aim of our study was to compare the late outcomes of patients who underwent on-pump redo coronary artery bypass surgery with those who had off-pump redo coronary artery bypass surgery.

Material and methods. Two groups of patients were compared. Group 1 consisted of 34 patients who underwent off-pump redo coronary artery bypass surgery, and Group 2 included 160 patients who underwent on-pump redo coronary artery bypass surgery. Both groups of patients were operated on by the same team of surgeons at the same time period. Groups did not differ by age, gender, functional class, preoperative myocardial infarction rate, and left ventricular function. More patients with hypertension were in the off-pump group. Significantly more grafts were performed in the on-pump group. Survival, presence of angina, reoccurrence of postoperative myocardial infarction, necessity of percutaneous transluminal coronary angioplasty and reoperations were evaluated in late follow-up period. The duration of follow-up was 3.37±2.15 years in the off-pump group and 3.27±2.36 years in the on-pump group.

Results. Survival after 6 years in the off-pump and on-pump redo coronary artery bypass surgery groups was 85.3% and 83.6%, respectively (P=0.758). Five years after redo operation, 54.9% of patients who underwent off-pump coronary artery bypass surgery and 69.3% of patients who underwent on-pump coronary artery bypass surgery had no angina (P=0.174). There were no major cardiac events (percutaneous transluminal coronary angioplasty, death, myocardial infarction, and reoperations) after 6 years in 69.7% of patients in the off-pump group and 76.9% of patients in the on-pump group (P=0.343). Five years after redo surgery, 79.4% of patients in the off-pump group and 91.9% in the on-pump group were free of percutaneous transluminal coronary angioplasty (P<0.02).

Conclusions. There was no difference in survival despite the fact that patients in the on-pump group received more grafts than those in the off-pump group. Recurrence of angina and incidence of major cardiac events were almost equal in both the groups. Percutaneous transluminal coronary angioplasty was more frequently performed in the patients of off-pump group at late follow-up.

Correspondence to L. Ivaškevičienė, Center of Cardiac Surgery, Vilnius University Hospital Santariškių Klinikos, Santariškių 2, 08661 Vilnius, Lithuania. E-mail: giedre.nogiene@santa.lt

Received 1 March 2009, accepted 6 November 2009