Does off-pump coronary artery bypass grafting negatively impact long-term survival and freedom from reintervention?

Area of Science:

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

Background:

• Recent evidence suggests potential concerns regarding late mortality and reintervention rates following off-pump coronary artery bypass grafting (OPCAB).
• Comparative long-term data are crucial for evaluating the safety and efficacy of OPCAB versus traditional on-pump coronary artery bypass grafting (ONCAB).

Purpose of the Study:

• To assess the 10-year impact of OPCAB on patient survival.
• To evaluate freedom from reintervention and cardiac-related hospital readmissions after OPCAB compared to ONCAB.

Main Methods:

• A comparative study of 307 patients undergoing isolated multivessel OPCAB versus 397 patients undergoing multivessel ONCAB between January 2002 and December 2002.
• Kaplan-Meier survival analysis and univariate and risk-adjusted comparisons were performed at the 10-year follow-up.
• Hazard ratios were calculated to assess predictors of mortality, readmission, and reintervention.

Main Results:

• Kaplan-Meier survival rates were similar between the OPCAB and ONCAB groups at 10 years.
• Risk-adjusted analysis indicated that OPCAB was not a significant independent predictor of long-term mortality (HR 0.91; 95% CI 0.70-1.12).
• OPCAB also did not significantly predict readmission for cardiac causes (HR 0.96; 95% CI 0.78-1.10) or the need for reintervention (HR 0.93; 95% CI 0.87-1.05).

Conclusions:

• Off-pump coronary artery bypass grafting does not adversely affect survival at 10 years compared to on-pump coronary artery bypass grafting.
• Freedom from reintervention and cardiac-related hospital readmissions are comparable between OPCAB and ONCAB at the 10-year follow-up.
• These findings suggest OPCAB is a safe and effective alternative for multivessel coronary artery bypass grafting with durable long-term results.