Mortality Lower With Off-Pump Bypass in Patients With Atheromatous Aortic Disease
NEW YORK (Reuters Health) – For patients with coronary artery disease complicated by atheromatous aortic disease, the mortality is halved and neurologic complications are cut by three-fold with off-pump bypass surgery compared with conventional heart-lung bypass surgery, New York University researchers announced on Monday at the 83rd annual meeting of the American Association of Thoracic Surgeons meeting in Boston.
Using routine intraoperative transesophageal echocardiography, the NYU team identified 458 patients with severe atheromatous aortic disease of the ascending aorta or the aortic arch who were scheduled for coronary artery bypass grafting. Off-pump bypass surgery (OPCAB) was performed in half of the patients, while the other half matched patients underwent conventional cardiopulmonary bypass (CPB-CABG).
The mortality rate for OPCAB was 5.2% compared with 10.9% for CPB-CABG. Stroke incidence was 2.2% for OPCAB compared with 6.1% for CPB-CABG. The postoperative complication-free rate was better with OPCAB, at 91.7% compared with 78.6% with CPB-CABG. Compared with OPCAB, the odds ratio associated with CPB-CABG was 3.4 for death, 8.1 for acute MI, 4.4 for renal dialysis, and 1.2 for peripheral vascular disease.
Dr. Eugene A. Grossi told Reuters Health that “it is still very controversial as to whether off-pump bypass surgery is better for patients who need bypass surgery, but for this subgroup, our data show that Äthis approachÅ is better.”
“The bypass machine changes the flow pattern,” Dr. Grossi explained. “It is like taking the equivalent of a pressure washer to the aorta…It stirs the garbage that is in the aorta up” in patients with concomitant atheromatous aortic disease, he explained.
“It’s like a river bend. The outside of the bend is sandy and smooth, but the inside of the bend has rocks and limbs and garbage. That’s what the aorta is like in this disease.”
Off-pump bypass surgery is more technically challenging, Dr. Grossi said, “but recent advances in technology are making it similar to ÄtraditionalÅ bypass surgery. We’re talking about retooling people,” he added.
The research was presented at the meeting by Dr. Grossi’s colleague, Dr. Ram Sharony.