Operative Invasiveness of Off-pump Coronary Artery Bypass Grafting

Objective:  In our institution, steroid is administrated intravenously during the anesthesia induction for conventional coronary artery bypass grafting( CABG) to prevent the inflammatory response due to cardiopulmonary bypass and reperfusion injury, however, steroid is not used for off-pump CABG (OPCAB) with expectation of less invasiveness of the procedure. We evaluated the early outcomes and postoperative inflammatory response of conventional CABG with preoperative steroid use and OPCAB.

Methods:  From May 2004 to April 2010, 120 patients underwent elective CABG requiring the ventricle elevation to expose the target vessels. Twenty eight patients(group C)treated with conventional CABG and 92 patients (group O) with OPCAB. Perioperative course was analyzed and compared between the 2 groups.

Results:  OPCAB had several advantages such as shorter operative duration, decreased requirement of blood transfusion and myocardial protection compared with conventional CABG. However, frequency of postoperative paroxysmal atrial fibrillation was similar between these techniques and early postoperative C-reactive protein levels were shown to be significantly higher in OPCAB.

Conclusions:  OPCAB has advantage over conventional CABG in blood loss during surgery and myocardial protection. However the inflammatory response was significantly severe in OPCAB. OPCAB might become less invasive with the anti-inflammatory medication.