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(Circulation. 2003;108:II-1.)
© 2003 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Off-Pump Coronary Artery Bypass (OPCAB) Surgery Reduces Risk-Stratified Morbidity and Mortality: A United Kingdom Multi-Center Comparative Analysis of Early Clinical Outcome

Sharif Al-Ruzzeh, FRCS; Gareth Ambler, PhD; George Asimakopoulos, FRCS; Rumana Z. Omar, PhD; Ragheb Hasan, FRCS; Brian Fabri, FRCS; Ahmed El-Gamel, FRCS; Anthony DeSouza, FRCS; Vipin Zamvar, FRCS; Steven Griffin, FRCS; Daniel Keenan, FRCS; Uday Trivedi, FRCS; Mark Pullan, FRCS; Alex Cale, FRCS; Michael Cowen, FRCS; Kenneth Taylor, FRCS; Mohamed Amrani, FRCS

From the National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, Harefield and Hammersmith Hospitals; The Department of Statistical Science, University College, London, United Kingdom.

Correspondence to Mohamed Amrani, Senior Lecturer in Cardiac Surgery, Harefield Hospital, Middlesex UB9 6JH, United Kingdom. Phone: 44-1895-828-550; Fax: 44-1895-828-992; E-mail: mr.amrani{at}rbh.nthames.nhs.uk

Objective— Off-Pump Coronary Artery Bypass (OPCAB) surgery is gaining more popularity worldwide. The aim of this United Kingdom (UK) multi-center study was to assess the early clinical outcome of the OPCAB technique and perform a risk-stratified comparison with the conventional Coronary Artery Bypass Grafting (CABG) using the Cardio-Pulmonary Bypass (CPB) technique.

Methods— Data were collected on 5,163 CPB patients from the database of the National Heart and Lung institute, Imperial College, University of London, and on 2,223 OPCAB patients from eight UK cardiac surgical centers, which run established OPCAB surgery programs. All patients had undergone primary isolated CABG for multi-vessel disease through a midline sternotomy approach, between January 1997 and April 2001. Postoperative morbidity and mortality were compared between the CPB and OPCAB patients after adjusting for case-mix. The mortality of the OPCAB patients was also compared, using risk stratification, to the mortality figures reported by the Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCTS) based on 28,018 patients in the national database who were operated on between January 1996 and December 1999.

Results— Morbidity and mortality were significantly lower in the OPCAB patients compared with the CPB patients and the UK national database of CABG patients, over the same period of time, after adjusting for case-mix.

Conclusion— This study demonstrates that risk stratified morbidity and mortality are significantly lower in OPCAB patients than CPB patients and patients in the UK national database.

Key Words: coronary surgery • ischemic heart disease • coronary heart disease • cardiopulmonary bypass