Outcomes of Beating Heart on Pump Utilizing a Miniature Bypass Circuit Versus off Pump Cardiac Bypass at a Veterans Affairs Medical Center.

2018 
BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) helps reduce systemic inflammatory changes by maintaining native pulsatile flow. This analysis evaluates the outcomes of OPCAB at a Veterans Affairs Medical Center (VAMC) and evaluates the use of beating heart on-pump (BHOP) bypass grafting as an empiric therapy for high-risk patients. METHODS: We performed a retrospective analysis of 756 patients who underwent coronary bypass grafting between 2004-2015 at a single VAMC. This group was subdivided into BHOP (N.=60) versus OPCAB (N.=696). Analysis was performed using multivariate regression modeling with P=0.05 holding statistical significance. RESULTS: Both cohorts were predominantly male with an average age of 65 years and average Body Mass Index of 30 kg/m2. Individuals in the BHOP group were more likely to have COPD and resting ST depressions preoperatively. Operative time was longer and average number of conduits was higher for BHOP cases compared to OPCAB cases respectively. After controlling for differences between cohorts, multivariate regression analysis showed a protective effect of both BHOP (OR 0.325, P=0.035; OR 0.323, P=0.031) and two (OR 0.385, P<0.001; OR 0.539, P=0.018) and three (OR 0.154, P<0.001; OR 0.315, P<0.001) vessel revascularization on three and six-year mortality following revascularization. CONCLUSIONS: Postoperative survival following BHOP is superior to OPCAB when BHOP is used empirically with no difference in short-term mortality. Empiric use of BHOP should be considered for high risk coronary revascularization.
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