Off-pump or on-pump coronary artery bypass at 30 days: A propensity matched analysis

Chen Wang; Yefan Jiang; Yu Song; Qingpeng Wang; Rui Tian; Dashuai Wang; Nianguo Dong; Xionggang Jiang; Si Chen; Xinzhong Chen

doi:10.3389/fcvm.2022.965648

Off-pump or on-pump coronary artery bypass at 30 days: A propensity matched analysis

Front Cardiovasc Med. 2022 Aug 1:9:965648. doi: 10.3389/fcvm.2022.965648. eCollection 2022.

Authors

Chen Wang¹, Yefan Jiang^{1

2}, Yu Song¹, Qingpeng Wang¹, Rui Tian¹, Dashuai Wang¹, Nianguo Dong¹, Xionggang Jiang¹, Si Chen¹, Xinzhong Chen¹

Affiliations

¹ Department of Cardiovascular Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
² Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Abstract

Introduction: This study was to determine whether coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG, OPCAB) could reduce early postoperative mortality and major complications compared with conventional coronary artery bypass grafting with cardiopulmonary bypass (on-pump CABG, ONCAB) by experienced surgeons.

Material and methods: From January 2016 to June 2020, isolated CABG was performed in 1200 patients (ONCAB 429, OPCAB 771) in Wuhan Union Hospital. The propensity score matching was used to adjust for differences in baseline characteristics between the ONCABG and OPCABG groups. After 1:1 matching, 404 pairs for each group were selected to compare outcomes within 30 days after surgery. All the operations were completed by experienced surgeons that had completed more than 500 on-pump and 200 off-pump CABG, respectively.

Results: After propensity matching, the two groups were comparable in terms of preoperative characteristics. The OPCAB group had less vein graft (2.5 ± 1.0 vs. 2.7 ± 0.9; P < 0.001) and a higher rate of incomplete revascularization (12.4 vs. 8.2%; P < 0.049) than the ONCAB group. There was no significant difference in early postoperative mortality between ONCAB and OPCAB groups (2.2 vs. 2.2%; P = 1.00). However, patients in the OPCAB group had a lower risk of postoperative stroke (1.5 vs. 4.7%; P = 0.008), new-onset renal insufficiency (8.9 vs. 18.8%; P < 0.001), respiratory failure (2.2 vs. 7.2%; P = 0.001), reoperation for bleeding (0.5 vs. 2.7%; P = 0.001), and required less ventilator assistance time (33.4 ± 37.9 h vs. 51.0 ± 66.1 h; P < 0.001) and intensive care unit (ICU) time (3.7 ± 2.7 days vs. 4.8 ± 4.3 days; P < 0.001).

Conclusions: In our study, patients undergoing OPCAB had fewer postoperative complications and a faster recovery. It is a feasible and safe surgical approach to achieve revascularization when performed by experienced surgeons.

Keywords: CABG; off-pump; on-pump; propensity score matching; short-term clinical outcomes.