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Off-pump coronary surgery in selected patients: better early outcome but more recurrence of angina?

^a Cardiac Surgery Department, Timone University Hospital, Marseilles, France
^b Anaesthesiology Department, Timone University Hospital, Marseilles, France
^c Cardiology Department, Timone University Hospital, Marseilles, France

*Corresponding author: Dr Thierry Caus, Service de Chirurgie Cardiaque, CHU Timone-Adultes, 264 rue Saint Pierre, 13385 Marseille, France. Tel.: +33 491385717; fax: +33 491384926.

E-mail address: tcaus{at}ap-hm.fr (T. Caus).

This non-randomized retrospective study included all patients operated on for CABG through median sternotomy between January 2000 and December 2002 by the same surgeon trained to both techniques. Using risk-adjusted comparison where expected mortality was given by the EuroSCORE value assessed pre-operatively, and studying mid-term survival and functional results we aimed to evaluate our indications for OPCAB versus conventional CABG through a consecutive series of 308 patients. Selected indications for OPCAB (n=154) were isolated LAD coronary system lesions and multivessel diseases with suitable anatomy in high surgical risk patients (EuroSCORE5). The first 154 patients operated on conventionally during the time-study interval were included in the control group. Expected mortality was significantly higher in the OPCAB group: 4.29 [95% CI: 3.83–4.77] vs. 3.54 [95% CI: 3.17–3.91] (P=0.024). Observed mortality was 1.3% and 2.6% for patients treated OPCAB and with conventional technique, respectively. Survival at three years was 91.5 and 93.8% in the conventional and OPCAB groups, respectively. Angina-free survival at three years was 95.8% and 89.6% in the conventional and OPCAB groups, respectively (P=0.04). To promote OPCAB in selected patients results in decreasing operative risk to the price of worsening late functional results.

Key Words: Coronary disease; Minimally invasive surgery