Equivalent midterm outcomes after off-pump and on-pump coronary surgery

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Minimally Invasive Cardiac Procedures

Background:

• Off-pump coronary artery bypass grafting (CABG) is associated with reduced early morbidity compared to on-pump CABG.
• Midterm outcomes of off-pump CABG require further investigation to assess long-term efficacy.

Purpose of the Study:

• To compare the midterm outcomes of propensity-matched patients undergoing off-pump versus on-pump coronary artery bypass grafting.
• To evaluate the impact of fewer bypass grafts in off-pump procedures on later survival and ischemic events.

Main Methods:

• A cohort study involving 812 propensity-matched patients (406 off-pump, 406 on-pump) from January 1997 to July 2000.
• Follow-up for time-related events including mortality, myocardial infarction, percutaneous coronary intervention, and coronary reoperation.
• 95% complete follow-up data at 4 years.

Main Results:

• At 4 years, survival rates were 87.5% (off-pump) and 91.2% (on-pump) (P=.2).
• Freedom from myocardial infarction, percutaneous coronary intervention, and coronary reoperation were comparable between groups.
• Freedom from the combined endpoint (mortality, MI, reintervention) was 75.2% for off-pump and 82.9% for on-pump (P=.14).

Conclusions:

• Off-pump and on-pump CABG demonstrate equivalent midterm outcomes.
• The reduced number of grafts in off-pump CABG did not negatively impact survival or increase ischemic events at 4 years.