Autor:

Rosendahl, U.; Albert, A.; Bauer, S.; Bauer, K.; Mortasawi, A.;
Ennker, IC.; Dalladaku, F.; Schröder, T.; Ennker, J.

Erscheinungsort:

Thorac Cardiovasc Surg 2001; 49 (Suppl 1):30

Inhalt:

Introduction: The intention to reduce the well established pitfalls associated with the use of cardio-pulmonary bypass (CPB) for CABG have lead to the introduction of minimally and less invasive methods into the field of coronary artery revascularization. Hypothetically postoperative outcome should be superior in the majority of patients undergoing Off-Pump CABG compared to those undergoing conventional CABG.

Methods: From 1997 to July 2000 Off-pump coronary artery bypass grafting was performed in a total of 407 patients. 62 Patients were revascularised through a antero-lateral-minithoracotomy as a MIDCAB procedure. 345 revaskularisations were performed through a median sternotomy in the OPCAB method. 71% of these patients received multiple bypasses. During the same period 4012 patients underwent CABG using CPB. The majority of patients undergoing Off-pump CABG were, due to concomitant diseases (i.e. neurological-, pulmonary-, renal disorders), at high risk for predicted complications due to the use of cardio-pulmonary bypass. Patients with severe reduction in ejection fraction (<25%) were excluded from Off-Pump procedures. Postoperative follow up data, including neuro-cognitive function, was assessed 3 and 6 month postoperatively.

Results: Patients undergoing Off-pump and On-pump CABG did not differ statistically significant regarding age and sex. Despite the higher incidence of concomitant diseases like carotid artery disease, neurological deficits, severe pulmonary deficiency, renal disease, etc. in the Off-pump group, the incidence of peri- and postoperative neurological deficits, respiratory insufficiency, renal failure, postoperative atrial fibrillation, mortality etc. did not reveal statistical significance between both groups. Statistical significant difference between the study-groups were only observed in the number of anastomoses performed and the relation of arterial and venous grafts used. Moreover there was no statistical significant difference in neuro-cognitive function between the study groups during the follow-up period.

Conclusion: Coronary artery bypass grafting without CPB is a reliable method leading to excellent results in selected high risk patients. In unselected cases, Off Pump coronary artery bypass grafting appears not to have a significant impact on outcome compared with conventional CABG. Additional studies need to prove the significance of long term benefits for patients undergoing this procedure.