CORONARY ARTERY BYPASS GRAFTING (CABG): OUTCOMES OF OFF-PUMP VS ON-PUMP CABG IN HIGH-RISK PATIENTS

Abstract

Background: Patients with advanced coronary artery disease often require CABG, but the choice of surgical technique becomes more important when patients have added clinical risk factors. In such cases, avoiding cardiopulmonary bypass may influence early recovery, postoperative complications, and length of hospital stay

Objective: This study assessed differences in early postoperative recovery and complication patterns among high-risk patients undergoing off-pump and on-pump CABG

Methods: This cross-sectional comparative study was performed at Prime Teaching Hospital, Peshawar, between January 2024 and January 2025.  Of the 72 enrolled patients, 36 underwent CABG without cardiopulmonary bypass, while the remaining 36 underwent CABG using cardiopulmonary bypass. Demographics, clinical profile, surgical and postoperative details were recorded. Data analysis was done with the help of SPSS (version 25) and a p-value of ≤0.05 was taken as significant.

Results: Both groups had similar demographic and preoperative clinical profiles. Compared with the on-pump group, patients in the off-pump group had shorter ICU admission (2.3 ± 0.9 vs 3.5 ± 1.2 days), reduced hospital stay (6.2 ± 1.5 vs 8.1 ± 2.0 days), and fewer hours of ventilatory support (10.5 ± 3.2 vs 16.8 ± 4.5 hours), with p=0.001 for each comparison. Acute kidney injury and atrial fibrillation were also less frequent after off-pump CABG. Mortality during admission and at 30 days did not show a statistically significant difference.

Conclusion: Off-pump CABG demonstrates better early postoperative outcomes with reduced complications in high-risk patients, although mortality outcomes remain comparable to on-pump CABG. It may be considered a preferable option in selected patients to improve recovery.