Off-pump versus on-pump redo coronary artery bypass grafting: A propensity score analysis of long-term follow-up.

Abstract

Redo coronary artery bypass grafting (CABG) is associated with an increased early mortality reported up to 16%. The aim of this study was to analyze the early and long-term results after redo CABG with special focus on the feasibility and safety of the off-pump technique in the setting of a high-volume off-pump CABG center. From January 2006 to June 2015, isolated redo CABG was performed in 304 patients (179 = on-pump redo CABG, 125 = off-pump redo CABG). We used propensity score matching with 14 preoperative variables to adjust for differences in baseline characteristics between the on-pump redo CABG and the off-pump redo CABG groups. After 1:1 matching we selected 108 pairs for each group. Mean follow-up rate was 4.01 years. The final sample was 83.9% men (n = 225) with a mean age of 69.77 ± 8 years. After propensity score matching there was a significant difference in the total number of grafts performed in favor of on-pump redo CABG (P = .011), whereas 66.7% (72 out of 108) of off-pump redo CABG patients received total arterial grafts. Off-pump redo CABG patients had a lower rate of postoperative renal failure necessitating dialysis (4.6% vs 0%; P = .06), required less recovery time in the intensive care unit (1.33 ± 1.03 days vs 4.4 ± 7.98 days; P < .001) and were discharged more quickly (10.08 ± 5.35 days vs 14.1 ± 10.6 days; P = .001). Off-pump redo CABG led to better long-term survival (log-rank test, P = .086). In our study, patients undergoing off-pump redo CABG had fewer postoperative complications, achieved faster recovery, and had better long-term survival. Hence, off-pump redo CABG is safe and feasible.