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Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
No major differences in 30-day outcomes in high-risk patients randomized to off-pump versus on-pump coronary bypass
Christian H Møller1, Mario J Perko, Jens T Lund
1Cardiothoracic Surgery, Department 2152, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. chm@ctu.rh.dk
Insights
Off-pump coronary artery bypass grafting is as safe as on-pump surgery for high-risk patients, showing similar short-term outcomes. This study compared both methods in patients with significant coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Off-pump coronary artery bypass grafting (CABG) is considered safe for low-risk patients.
- Observational data suggest potential benefits of off-pump CABG in high-risk populations.
- Previous studies have not definitively compared on-pump versus off-pump CABG in high-risk individuals.
Purpose of the Study:
- To compare 30-day adverse outcomes in high-risk patients undergoing off-pump versus on-pump coronary artery bypass grafting.
- To evaluate the safety and efficacy of both surgical techniques in a high-risk cohort.
- To provide evidence for clinical decision-making in complex CABG cases.
Main Methods:
- A randomized trial involving 341 high-risk patients (EuroSCORE ≥ 5, 3-vessel disease).
- Patients were assigned to either off-pump or on-pump coronary artery bypass grafting.
- Outcomes were tracked via the Danish National Patient Registry and adjudicated by a blinded committee.
Main Results:
- No significant difference in the composite primary outcome (adverse cardiac/cerebrovascular events) at 30 days (15% vs. 17%, P=0.48).
- Individual adverse event rates, including mortality and myocardial infarction, were similar between groups.
- Fewer grafts were performed to the lateral left ventricle territory in the off-pump group (P=0.01).
Conclusions:
- Both off-pump and on-pump CABG are viable options for high-risk patients.
- Short-term complication rates are low for both surgical approaches in this population.
- The study provides valuable data on the comparative safety of CABG techniques in high-risk individuals.
Background:
Off-pump coronary artery bypass grafting compared with coronary revascularization with cardiopulmonary bypass seems safe and results in about the same outcome in low-risk patients. Observational studies indicate that off-pump surgery may provide more benefit in high-risk patients. Our objective was to compare 30-day outcomes in high-risk patients randomized to coronary artery bypass grafting without or with cardiopulmonary bypass.
Methods And Results:
We randomly assigned 341 patients with a EuroSCORE > or = 5 and 3-vessel coronary disease to undergo coronary artery bypass grafting without or with cardiopulmonary bypass. Patients were followed through the Danish National Patient Registry. The primary outcome was a composite of adverse cardiac and cerebrovascular events (ie, all-cause mortality, acute myocardial infarction, cardiac arrest with successful resuscitation, low cardiac output syndrome/cardiogenic shock, stroke, and coronary reintervention). An independent adjudication committee blinded to treatment allocation assessed the outcomes. Baseline characteristics were well balanced between groups. The mean number of grafts per patient did not differ significantly between groups (3.22 in off-pump group and 3.34 in on-pump group; P=0.11). Fewer grafts were performed to the lateral part of the left ventricle territory during off-pump surgery (0.97 versus 1.14 after on-pump surgery; P=0.01). No significant differences in the composite primary outcome (15% versus 17%; P=0.48) or the individual components were found at 30-day follow-up.
Conclusions:
Both off- and on-pump coronary artery bypass grafting can be performed in high-risk patients with low short-term complications. CLINICAL TRIAL REGISTRATION- clinicaltrials.gov. Identifier: NCT00120991.
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