OPCAB in the minimally invasive era: impact on wound complications—a comparative study with on-pump CABG

Background The impact of off-pump coronary artery bypass grafting (OPCAB) on great saphenous vein (GSV) harvest-site wound complications and graft integrity remains uncertain in the contemporary era. We compared harvest-site morbidity, early angiographic outcomes, and long-term clinical events between OPCAB and conventional on-pump coronary artery bypass grafting (CABG). Methods This single-center retrospective study included 394 patients who underwent isolated CABG with available pre- and postoperative coronary angiography between 2005 and 2017. Propensity score matching according to pump usage yielded 157 matched pairs on-pump CABG, n = 157; OPCAB, n = 157. The primary endpoint was GSV harvest-site wound complications. Secondary endpoints included early graft occlusion or saphenous vein graft (SVG) stenosis, reintervention, perioperative outcomes, and major adverse cardiac and cerebrovascular events (MACCE). Results After matching, baseline characteristics were comparable, although the on-pump group had more distal anastomoses. Leg wound complications were rare and similar between groups (1.3% vs. 0.6%, p = 1.00). Early graft occlusion (9.6% vs. 10.3%, p = 0.553) and SVG occlusion (5.7% vs. 4.5%, p = 0.798) did not differ significantly. SVG stenosis severity and reintervention rates were comparable. OPCAB was associated with shorter operative time, fewer red blood cell transfusions (49.7% vs. 64.3%, p = 0.012), shorter intensive care unit stay, and reduced hospital stay. Thirty-day mortality and 12-month MACCE rates (12.1% in both groups) were similar. Long-term MACCE-free survival up to 10 years showed no significant difference. Conclusion OPCAB did not reduce GSV harvest-site complications compared with on-pump CABG. Early graft integrity and long-term clinical outcomes were comparable, although OPCAB improved perioperative resource utilization.