On-pump versus off-pump coronary-artery bypass surgery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Outcomes Research

Background:

• Coronary-artery bypass grafting (CABG) is a standard procedure for coronary artery disease.
• Traditionally, CABG utilizes cardiopulmonary bypass (on-pump CABG).
• Off-pump CABG aims to reduce complications associated with the heart-lung machine.

Purpose of the Study:

• To compare the short-term and long-term outcomes of off-pump versus on-pump CABG.
• To evaluate secondary endpoints including revascularization completeness, graft patency, and neuropsychological outcomes.

Main Methods:

• A randomized trial involving 2203 patients scheduled for urgent or elective CABG.
• Patients were assigned to either on-pump or off-pump CABG procedures.
• Primary endpoints included a composite of death or complications at 30 days and a composite of death, repeat revascularization, or myocardial infarction at 1 year.

Main Results:

• No significant difference in the 30-day composite outcome between off-pump and on-pump CABG (7.0% vs. 5.6%, P=0.19).
• The 1-year composite outcome was significantly higher in the off-pump group (9.9% vs. 7.4%, P=0.04).
• Off-pump CABG had lower graft patency (82.6% vs. 87.8%, P<0.01) and less complete revascularization (17.8% vs. 11.1%, P<0.001).

Conclusions:

• At 1-year follow-up, off-pump CABG was associated with worse composite outcomes and poorer graft patency compared to on-pump CABG.
• No significant differences were observed in neuropsychological outcomes or resource utilization between the two techniques.