• Mahrukh Zahoor, Muhammed Mafsheen Iqbal, Shahab Naqvi, Azhar Rasheed, and S Afzal Ahmad.
• Department of Cardiac Surgery, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Pakistan. mahrukh04@yahoo.com
• J Ayub Med Coll Abbottabad. 2008 Jan 1; 20 (1): 26-30.

BackgroundCoronary Artery Bypass Grafting (CABG) with cardiopulmonary bypass (CPB) on one hand allows controlled haemodynamics with superior graft quality while on the other hand carries inherent risks of CPB which has renewed interest in Off-pump coronary artery bypass (OPCAB). Haemodynamic instability and intraoperative dysrythmias are major procedural complications of OPCAB, threatening conversion to emergency on-pump surgery. The purpose of this study was to compare intraoperative dysrythmias and inotropic use for haemodynamic stabilization during OPCAB surgery against conventional CABG.MethodsConsecutive CABG cases operated between 1st June 2003 and 31st May 2006 were included while conversions were excluded. Primary end points were analyzed using chi square and t test and values described in percentages, means and probability (p value).ResultsSix hundred and eighty-four cases were divided in group-A (on-pump, n = 574) and B (OPCAB, n = 97). Conversion rate was 11.8%. Intraoperative dysrythmias (A, 3.5%, B, 15%, p < 0.0001) and use of inotropic support was higher in group-B (A, 15.3%, B, 30.3%, p < 0.0001). Actual mortality in group-B was higher than the predictive value (A, 3.8%, B, 3.6%, Predictive value 3-5% and 0-3% respectively).ConclusionOPCAB leads to higher frequency of dysrythmias and inotropic use intraoperatively, highlighting lower procedural safety over conventional CABG.

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