Objective

Redo-CABG remains a challenging operation that is associated with increased morbidity and mortality. Off-pump coronary surgery might be a valuable alternative for patients requiring redo-CABG although very little data is available in the literature on its impact on early and long-term health outcome. The aim of this study was to compare early and long term health outcome in patients undergoing redo-CABG with either on-pump or off-pump coronary surgery.

Methods

Retrospective analysis of single unit prospectively collected data between May 1996 and February 2014. 349 patients underwent isolated Redo CABG. Of these, 143 (40.9%) underwent off-pump CABG (OPCABG) and 206 (59.1%) on-pump CABG (ONCABG). The two groups were similar in terms of pre-operative characteristics, although the OPCABG group was on average older (mean age 67 ± 8.2 vs 65.7±8.6, p=0.02) and presented with a higher rate of peripheral vascular disease (26.6% vs 13.6%, p=0.03).

Results

No significant differences were found in terms of in-hospital mortality (2.1 %vs5.8%, p=0.15), CVA (0.7%vs 1%, p=0.9), AKI (12.9%vs 18.3%, p=0.53) and completeness of revascularization(76.1%vs 75.6%,p=0.9), all OPCABGvs ONCABG respectively. IABP use was higher in ONCABG (11.2% vs 2.8%, p <0.01). Long term survival was similar at 1, 5 and 10 years (p=0.78). A sub-analysis of patients with reduced LVEF showed similar results, but there was a tendency to higher in-hospital mortality in ONCABG (11.3%vs2.2%, p=0.08).

Conclusion

Off-pump coronary artery bypass is a safe and valid alternative surgical approach in redo-CABG surgery with a low incidence of early mortality and morbidity rate as well as a long-term survival comparable to the conventional on-pump surgery.