In hospital outcome of patients undergoing coronary endarterectomy: comparison between off-pump vs on pump CABG.

BACKGROUND: Due to advancement of non-surgical methods of coronary revascularization the patients referred for surgery have extensive and complex coronary anatomy. Patients with diffuse atheromatous coronary artery disease required coronary artery reconstruction or coronary endarterectomy (CE). Coronary endarterectomy on beating heart needs skill and better surgical technique. Coronary endarterectomy along with coronary artery bypass grafting (CABG) done on beating heart is compared with coronary endarterectomy done by using conventional CABG technique.

METHODS: Seven hundred and ninety five consecutive patients underwent CABG from January 2006 to March 2007 in a prospective randomized trial at cardiac surgery department, Punjab Institute of Cardiology, Lahore; out of these 115 patients underwent coronary endarterectomy (CE) and were included in this study.

RESULTS: Coronary artery bypass grafting was performed in 115 patients. Seventy two (62.6%) were in group A on-pump and 43 (37.39%) were in group B off-pump. Mean age in group A was 55.68 +/- 1.06 and 52.63 +/- 1.40 in group B. Sixty six male and 6 female were included in group A, 40 male and 3 female patients were in group B. In-hospital mortality among patients undergoing CABG was 5.6 % in on-pump group and 2.3 % in off-pump group (p = 0.649), the duration of post-operative mechanical ventilation in on-pump was 6.78 +/- 9.34 hours and 5 +/- 4.0 hours in off-pump group (p = 0.060), 66.7% patients in on-pump and 58.1% patients in off-pump group required blood transfusions, Intra-aortic balloon pump (IABP) was required in 5.6% of the patients in on-pump group. Other factors included, smoking 26.4% in on-pump and 41.9% in off-pump group (p = 0.01), Intensive care unit (ICU) stay was statistically significant 4 +/- 3 in on-pump group and 4 +/- 2 in off-pump group (p = 0.02), and drain in on-pump group was 455 +/- 208 ml and 540 +/- 370 ml in off-pump group (p = 0.01).

CONCLUSION: Coronary endarterectomy (CE) has higher post-operative morbidity and mortality but the post-operative outcome after the procedure on either technique is comparable and CE is feasible on off-pump technique as well.