Effectiveness of revascularization and immediate outcomes after off-pump coronary artery bypass surgery using microvascular techniques and surgical microscope. (Propensity score matching)

Semchenko A.N.; Makarov A.D.; Khudyakov D.S.; Zharenkov M.S.

doi:https://doi.org/10.17116/Cardiobulletin20262101149

Semchenko A.N.

Federal Center for Cardiovascular Surgery, Khabarovsk, Russia

ORCID: 0000-0001-7132-0675

Makarov A.D.

Federal Center for Cardiovascular Surgery, Khabarovsk, Russia

ORCID: 0000-0003-2580-3531

Khudyakov D.S.

Federal Center for Cardiovascular Surgery, Khabarovsk, Russia

ORCID: 0009-0007-9511-034X

Zharenkov M.S.

Federal Center for Cardiovascular Surgery, Khabarovsk, Russia

ORCID: 0000-0003-2069-6044

Effectiveness of revascularization and immediate outcomes after off-pump coronary artery bypass surgery using microvascular techniques and surgical microscope. (Propensity score matching)

Authors:

Semchenko A.N., Makarov A.D., Khudyakov D.S., Zharenkov M.S.

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Journal: Russian Cardiology Bulletin. 2026;21(1): 49‑59

DOI: 10.17116/Cardiobulletin20262101149

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To cite this article:

Semchenko AN, Makarov AD, Khudyakov DS, Zharenkov MS. Effectiveness of revascularization and immediate outcomes after off-pump coronary artery bypass surgery using microvascular techniques and surgical microscope. (Propensity score matching). Russian Cardiology Bulletin. 2026;21(1):49‑59. (In Russ.)
https://doi.org/10.17116/Cardiobulletin20262101149

Подписка 2026 Кардиологический вестник (Russian Cardiology Bulletin)

Использование инфографики авторами научных работ

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OBJECTIVE

To analyze the efficacy of revascularization and immediate outcomes of on-pump and off-pump coronary artery bypass grafting (CABG) using microsurgical techniques and microscope.

MATERIAL AND METHODS

A single-center retrospective study included 534 patients who underwent CABG using microsurgical techniques and microscope between 2014 and 2024: group 1 (off-pump, n=100) and group 2 (control, on-pump, n=434). Propensity score matching (PSM) was applied to balance both groups for 19 parameters (89 pairs). The primary endpoint was efficacy of revascularization (patency of all grafts). Secondary endpoints included in-hospital and 30-day mortality, myocardial infarction, stroke, repeat revascularization; specific complications (acute kidney injury, atrial fibrillation, etc.); and surrogate markers.

RESULTS

Revascularization efficacy was comparable between groups before (85% vs. 83.2%, p=0.765) and after PSM (86.5% vs. 84.3%, p=0.832). Omission of cardiopulmonary bypass did not affect this outcome (OR after PSM: 1.20; 95% CI 0.52—2.76, p=0.671). There were no significant differences in rates of in-hospital/30-day mortality, myocardial infarction, stroke, or repeat revascularization. Before PSM, the off-pump group demonstrated significant advantages: lower incidence of acute kidney injury (AKI) (p=0.001) and atrial fibrillation (AF) (p=0.036), shorter ventilation time (p=0.008), less need for red blood cell transfusion (p=0.013), higher hematocrit (p=0.005) and glomerular filtration rate (GFR) (p<0.001), lower creatine kinase-MB (CK-MB) (p<0.001) and shorter hospital stay (p<0.001). After PSM (89 pairs), the advantages of the off-pump group persisted for key indicators: shorter ventilation (p=0.011), lower CK-MB (p<0.001), higher GFR (p=0.010), as well as a lower incidence of AKI (p=0.031) and AF (p=0.047).

CONCLUSION

In CABG with microsurgical technique and microscope, omission of cardiopulmonary bypass does not compromise revascularization efficacy. Moreover, it is associated with more favorable early postoperative course.

Keywords:

coronary artery bypass grafting

cardiopulmonary bypass

microsurgery

Authors:

Semchenko A.N.

Federal Center for Cardiovascular Surgery, Khabarovsk, Russia

ORCID: 0000-0001-7132-0675

Makarov A.D.

Federal Center for Cardiovascular Surgery, Khabarovsk, Russia

ORCID: 0000-0003-2580-3531

Khudyakov D.S.

Federal Center for Cardiovascular Surgery, Khabarovsk, Russia

ORCID: 0009-0007-9511-034X

Zharenkov M.S.

Federal Center for Cardiovascular Surgery, Khabarovsk, Russia

ORCID: 0000-0003-2069-6044

Received:

04.06.2025

Accepted:

08.09.2025

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References:

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