[Off and On-pump Coronary Artery Bypass;Single Institutional Analysis and National Database Analysis Using Propensity Score].

OBJECTIVES: The purpose of this study was to evaluate early and long term surgical results of offpump coronary artery bypass( OPCAB) in comparison with on-pump coronary artery bypass( ONCAB) using single institutional and Japan national database( JACVSD).

METHODS: Study 1:In our institution, between 1998 and 2012, 1,030 consecutive patients underwent isolated coronary artery bypass surgery. Using stratification method by propensity scores, early and late surgical results were evaluated. Study 2:In JACVSD, between 2008 and 2010, 24,287 patients who underwent isolated coronary artery bypass were reported. After propensity score matching, 2,955 cases in each group were selected.

RESULTS: Study 1:OPCAB significantly reduced intubation period( p<0.001), intensive care unit( ICU) stay( p<0.001), and operative mortality( p=0.022). Kaplan-meier analyses showed there was no statistical difference between OPCAB and ONCAB in major adverse cardiac and cerebrovascular event (MACCE) and mortality. Long term result analyses showed risk of MACCE (p=0.886)and mortality (p=0.437)was similar in both groups. Study 2:Thirty day( p=0.051) and hospital mortality( p=0.053) were less frequent in OPCAB group. Rate of composite( p<0.001), re-bleeding( p=0.004), dialysis( p=0.005), prolonged intensive care unit stay( p<0.001), prolonged ventilation( p<0.001)and gastrointestinal bleeding( p<0.001)was significantly lower in OPCAB after matching.

CONCLUSIONS: Both study showed less invasiveness of OPCAB.