Comparison of short cross clamp on-pump CABG and off-pump CABG in terms of postoperative morbidity and mortality in patients undergoing isolated coronary artery bypass grafting

Aim: This study aimed to compare the early outcomes of short cross-clamp on- pump coronary artery bypass grafting (CABG) with those of off-pump surgery. The effect of shortening cardiopulmonary bypass (CPB) duration on postoperative complications and major adverse cardiovascular events (MACCE) was investigated. Material and Method: A total of 1,362 patients who underwent isolated coronary artery bypass grafting (CABG) were retrospectively analyzed. In the on- pump group, receiver operating characteristic (ROC) analysis was performed to determine cross-clamp duration thresholds based on cardiac complications and major adverse cardiovascular events (MACCE), identifying two cutoff values of 81 and 108 minutes. The short cross-clamp on-pump group was compared with off-pump patients in terms of demographic, perioperative, and postoperative variables. Continuous variables were analyzed using the Student's t-test or Mann–Whitney U test, and categorical variables were analyzed using the chi-square test. Results: The off-pump group had significantly lower rates of MACCE (7.9% vs. 18.0%, p=0.046), cardiac (14.9% vs. 31.6%, p=0.012), and pulmonary complications (5.9% vs. 26.3%, p=0.008). Intensive care (1.9±1.1 vs. 2.8±1.4 days, p=0.001) and hospital stay (5.3±1.8 vs. 6.5±1.9 days, p=0.002) were also shorter in the off-pump group. No significant differences were found in renal (5.3% vs. 8.8%, p=0.41), neurological complications, or mortality rates (p>0.05). Conclusion: Although short cross-clamp on-pump CABG provides better surgical exposure and graft quality, the off-pump technique is associated with lower early complication rates. Optimization of CPB duration may reduce adverse effects; however, off-pump surgery appears more protective in terms of early morbidity. Keywords: Aortic clamp; Cardiopulmonary bypass; Coronary artery bypass; Coronary artery bypass, off-pump