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Published on: December 11, 2017
Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study
D van Dijk1, A P Nierich, E W Jansen
1University Medical Center Utrecht, Department of Anesthesiology, the Julius Center for Patient Oriented Research, Utrecht, The Netherlands.
Insights
Off-pump coronary artery bypass grafting (CABG) surgery is safe and offers similar short-term cardiac outcomes compared to on-pump CABG. This approach may reduce the need for blood transfusions and shorten hospital stays.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
Background:
- Coronary artery bypass surgery (CABG) traditionally uses cardiopulmonary bypass, associated with significant morbidity.
- Off-pump CABG, facilitated by cardiac stabilizers, offers an alternative but its comparative cardiac outcomes were unclear.
Purpose of the Study:
- To compare the cardiac outcomes of off-pump CABG versus on-pump CABG.
- To evaluate in-hospital results, cardiac outcomes, and quality of life after 1 month.
Main Methods:
- A multicenter trial randomized 281 patients to either off-pump or on-pump CABG.
- Cardiac outcome was defined as survival free of stroke, myocardial infarction, and coronary reintervention.
- Data collected included blood product usage, enzyme release, complications, length of stay, and quality of life.
Main Results:
- Completeness of revascularization was similar between groups.
- Off-pump CABG required fewer blood products (3% vs 13%) and showed less creatine kinase release.
- No significant differences in major complications, 1-month mortality, or quality of life were observed; cardiovascular event-free survival was comparable (93.0% vs 94.2%).
Conclusions:
- Off-pump CABG is a safe alternative for selected patients.
- Short-term cardiac outcomes after off-pump CABG are comparable to on-pump procedures.
- Off-pump CABG may offer benefits such as reduced blood product use and shorter hospital stays.
Background:
The use of cardiopulmonary bypass during coronary artery bypass surgery (CABG) has been associated with substantial morbidity. The recent introduction of cardiac stabilizers facilitates CABG without cardiopulmonary bypass (off-pump CABG), but it is unknown whether cardiac outcome after off-pump surgery is similar to that for the on-pump procedure.
Methods And Results:
In a multicenter trial, 281 patients (mean age 61 years, SD 9 years) were randomly assigned to off-pump or on-pump CABG. In-hospital results and cardiac outcome and quality of life after 1 month are presented. Cardiac outcome was defined as survival free of stroke, myocardial infarction, and coronary reintervention. The mean numbers of distal anastomoses per patient were 2.4 (SD 1.0) and 2.6 (SD 1.1) in the off-pump and on-pump groups, respectively. Completeness of revascularization was similar in both groups. Blood products were needed during 3% of the off-pump procedures and 13% of the on-pump procedures (P<0.01). Release of creatine kinase muscle-brain isoenzyme was 41% less in the off-pump group (P<0.01). Otherwise, no differences in complications were found postoperatively. Off-pump patients were discharged 1 day earlier. At 1 month, operative mortality was zero in both groups, and quality of life had improved similarly. In both groups, 4% of the patients had recurrent angina. The proportions of patients surviving free of cardiovascular events were 93.0% in the off-pump group and 94.2% in the on-pump group (P=0.66).
Conclusions:
In selected patients, off-pump CABG is safe and yields a short-term cardiac outcome comparable to that of on-pump CABG.
