Introduction : The aim of this non randomised, retrospective study was to evaluate, whether the choice of the surgical technique influences revascularization strategies.
Methods : All the patients (579) who underwent CABG surgery via a median sternotomy during the last two years in our department (Dept. of Cardiothoracic Surgery, LKH-Klagenfurt) were evaluated. 297 patients were operated in the conventional way with the use of CPB, 282 patients (49%) without CPB (270 OPCAB, 13 MIDCAB). The demographic data were similar in both groups, preoperative risk evaluation showed comparabel scoring. (Parsonnet, Euroscore). The number of grafts/patient was 2,7 versus 3,1 (mean, off-on pump).
Results : The operative mortality was 1,4% in our OPCAB group compared to a mortality rate of 3.7 % in our On- pump group. There was a trend to a decreased perioperative infarction rate in the OPCAB patients (2,8% versus 4,8%). Perioperative blood loss i.e. the need for perioperative blood transfusions was significantly lower in the Off-pump group. The drop of platelets and CK/CKMB release was significantly lower in the OPCAB group.
Discussion : There was a slight difference between the two groups concerning the number of grafts/patient. In the sub-group of patients who received at least three grafts (the majority of patients with single- or double-vessel diseases are operated on without CPB in our department), the number of grafts/patient was the same in the on- and off-pump group (3,4 versus 3,3 grafts/pat.).
Conclusion : The concept of incomplete target vessel revascularization might be an option in selected highest-risk patients. Since the long term outcome and freedom from angina may be affected by incomplete revascularization, we are still following the concept of complete revascularization in the majority of our patients.