Emergency coronary artery bypass grafting can be performed safely without cardiopulmonary bypass in selected patients.

Abstract

Patients requiring emergency surgical revascularization are often not considered for off-pump coronary artery bypass grafting (OPCAB). From 1996 to 2003, 614 patients underwent emergency coronary artery bypass grafting (Society of Thoracic Surgeons definition) at an academic institution. Forty-four (7%) of these procedures were performed without cardiopulmonary bypass, while 570 were conventional coronary artery bypass procedures with cardiopulmonary bypass (CABG/CPB). Data were collected prospectively into a computerized database and reviewed retrospectively. Though a greater proportion of CABG/CPB patients had critical left main stenosis (15.9% vs 38.3%, p = 0.005), other preoperative risk factors were similar between groups. Completeness of revascularization (No. distal anastomoses/No. diseased vessel systems) was significantly greater in the CABG/CPB group (1.51 +/- 0.03 vs 1.25 +/- 0.07, p = 0.003). There were no differences among individual complication rates (death, cardiac reoperation, postoperative myocardial infarction, permanent cerebral vascular accident, deep sternal wound infection, renal failure requiring hemodialysis, and respiratory failure requiring reintubation). However, the combined incidence of these endpoints was significantly lower in the OPCAB group (6.8% vs 21.1%, p = 0.038). OPCAB patients received fewer blood transfusions (65.9% vs 84.9%, p = 0.004) and had a significantly shorter intensive care unit stay (1.47 vs 3.20 days, p = 0.016). In-hospital mortality (0% vs 6.3%, p = 0.168) and mean postoperative length of stay (5.48 vs 7.03 days, p = 0.414) favored OPCAB, but did not reach statistical significance. Off-pump coronary artery bypass can be performed safely and effectively and should be considered in selected patients with acceptable hemodynamics undergoing emergency coronary revascularization.