Objective : We compared two groups of consecutive patients operated for coronary artery disease between January and December 2000. Group 1 included CABG patients operated with the use of extracorporeal circulation (n=230) and Group 2 beating heart surgery using the Octopus II plus stabiliser (n=228). Both groups were subdivided in high-risk and multivessel patients for statistical analysis.
Methods : Euroscore was used for risk stratification. High-risk patients carried a Euroscore over 6. Multivessel revascularization (> 3 distal anastomoses) was evaluated separately in both groups. There were some differences between the preoperative variables of all groups. Calcification of the ascending aorta, carotid artery disease and chronic obstructive lung disease were statistically significant more prevalent in Group 2 (p<0.001).
Results : All patients underwent full revascularization through midline sternotomy. A significant lower incidence of atrial fibrillation (p=0,027) shorter ICU stay (p=0,031) and renal insufficiency (p=0,033) was diagnosed in Group 2. The benefits of the beating heart surgery were even more pronounced in the high-risk patient group as indicated by a significant reduction in post-operative mortality and morbidity (p<0.001). In the multivessel groups, we found similar results. No strokes or TIA were noticed in the beating heart group (respectively 5,48% and 1,37% in Group 1 for high-risk and multivessel revascularization).
Conclusion : High-risk patients took advantage of the beating heart technique. Multivessel revascularisation even in the high-risk group can be performed safely. Especially elderly, sicker patients benefit from off-pump surgery.