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Early outcome of a randomized comparison of off-pump and on-pump multiple arterial coronary revascularization
Junjiro Kobayashi1, Tadashi Tashiro, Masami Ochi
1Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka 565-8565, Japan. jkobayas@hsp.ncvc.go.jp
Insights
Off-pump coronary artery bypass grafting (CABG) with multiple arterial grafts is as safe as on-pump CABG, showing similar revascularization and early graft patency. This approach may reduce certain biomarkers indicating cardiac and neurological injury.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Arterial Grafting Techniques
Background:
- Previous studies on off-pump vs. on-pump coronary artery bypass grafting (CABG) yielded conflicting results regarding cardiac, neurological events, and graft patency.
- Existing randomized trials often used limited arterial grafts, necessitating further investigation with multiple arterial grafts.
Purpose of the Study:
- To compare the safety and efficacy of off-pump CABG versus on-pump CABG using multiple arterial grafts.
- To evaluate clinical outcomes, biochemical markers of injury, and early graft patency between the two surgical techniques.
Main Methods:
- A prospective randomized controlled study involving 167 patients undergoing elective primary CABG.
- Patients were assigned to either multiple arterial off-pump CABG (n=81) or on-pump CABG (n=86).
- Clinical outcomes, S-100 protein, neuron-specific enolase, and creatine kinase-MB levels were assessed, along with early graft patency via angiography.
Main Results:
- No hospital deaths occurred in either group. Operation time was significantly shorter for off-pump CABG.
- Off-pump CABG showed a higher frequency of no need for transfusion and significantly lower levels of S-100 protein, neuron-specific enolase, and maximum creatine kinase-MB.
- Overall early graft patency was similar (98%), but stenosis-free patency was slightly worse in the off-pump group (93% vs. 96%), particularly in the right coronary area (90% vs. 99%).
Conclusions:
- Off-pump CABG with multiple arterial grafts is a safe alternative to conventional on-pump CABG.
- Both techniques demonstrated similar completeness of revascularization and overall early graft patency.
- The off-pump approach may offer benefits in reducing perioperative biochemical markers of cardiac and neurological injury.
Background:
Previous randomized comparisons of off-pump and on-pump coronary artery bypass grafting (CABG) have yielded controversial results about the cardiac and neurological events and graft patency. In addition, these randomized studies were composed of CABG with a few arterial grafts. We performed a prospective randomized controlled study to compare off-pump and on-pump CABG with multiple arterial grafts.
Methods And Results:
Between July, 2002, and September, 2004, 167 consecutive unselected patients referred for elective primary CABG were randomly assigned to undergo multiple arterial off-pump CABG (n=81) or on-pump CABG (n=86). The clinical outcomes and S-100 protein, neuron-specific enolase, and maximum creatine kinase-MB levels were compared. Early graft patency was examined within 3 weeks after the operation by angiography. The number of grafts performed per patient (3.5+/-1.0 for off-pump CABG and 3.6+/-0.9 for on-pump CABG) and the number of arterial grafts performed per patient (3.3+/-1.0 for off-pump CABG and 3.4+/-0.9 for on-pump CABG) were similar. Completeness of revascularization (completed grafts/planned grafts) was 98% in both procedures. There were no hospital deaths in either group. The operation time was significantly (P<0.001) shorter in the off-pump group than in the on-pump group (267+/-60 minutes versus 307+/-59 minutes). The incidence of perioperative complications was similar. The frequency of no need for transfusion was higher in the off-pump group than in the on-pump group (80% versus 55%, P<0.001). The S-100 protein levels at the admission into the intensive care unit were significantly (P<0.001) lower in the off-pump group than in the on-pump group (0.20+/-0.11 ng/mL versus 0.34+/-0.22 ng/mL). The neuron-specific enolase levels at the intensive care unit admission were significantly (P<0.001) lower in the off-pump group than in the on-pump group (10.4+/-9.0 ng/mL versus 16.9+/-6.9 ng/mL). Maximum creatine kinase-MB levels were significantly (P=0.046) lower in the off-pump group than in the on-pump group (17.1+/-16.7 IU/L versus 21.5+/-10.6 IU/L). The overall early graft patency rate with or without stenosis was the same (98%) in both groups, but the rate without stenosis was slightly worse in the off-pump group (93%) than in the on-pump group (96%) (P=0.093). The stenosis-free patency rate in the right coronary area was significantly (P=0.028) worse in the off-pump CABG group (90%) than in the on-pump group (99%).
Conclusions:
Off-pump CABG with multiple arterial grafts was as safe as the conventional on-pump CABG, with similar completeness of revascularization and early graft patency.
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