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Published on: March 27, 2018
Long-term follow-up of off-pump and on-pump coronary artery bypass grafting
Shahzad G Raja1, Umberto Benedetto, Dimple Chudasama
1From the Departments of *Cardiac Surgery, and †Quality and Safety, Harefield Hospital, London, UK.
Insights
Off-pump coronary artery bypass grafting (CABG) is a safe and effective myocardial revascularization strategy. This study found no adverse impact on long-term survival or need for reintervention compared to on-pump CABG.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Off-pump coronary artery bypass grafting (CABG) offers potential benefits but raises concerns about long-term efficacy.
- Assessing the long-term impact of off-pump CABG on mortality and reintervention is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the long-term outcomes of off-pump CABG.
- To compare long-term mortality and freedom from reintervention between off-pump and on-pump CABG.
Main Methods:
- A comparative study of 307 patients undergoing off-pump CABG versus 397 patients undergoing on-pump CABG from January 2002 to December 2002.
- Prospective collection of perioperative data.
- Univariate and risk-adjusted comparisons at 10-year follow-up.
Main Results:
- Off-pump CABG was not a significant predictor of long-term mortality (HR, 0.91; 95% CI, 0.70-1.12).
- No significant difference was observed in readmission for cardiac causes (HR, 0.96; 95% CI, 0.78-1.10).
- The need for reintervention was not significantly impacted by off-pump CABG (HR, 0.93; 95% CI, 0.87-1.05).
Conclusions:
- Off-pump CABG is a safe and effective myocardial revascularization strategy.
- Long-term follow-up demonstrates no adverse effects on survival or freedom from reintervention.
- The findings support the continued use of off-pump CABG for suitable patients.
Objective:
Despite increasing recognition of the benefits of off-pump coronary artery bypass grafting (CABG), concerns persist regarding its impact on long-term mortality and freedom from reintervention. In this study, we assessed the impact of off-pump CABG on long-term outcomes.
Methods:
From January 2002 to December 2002, a total of 307 consecutive patients who underwent isolated multivessel off-pump CABG at our institution were compared with a control group of 397 patients who underwent multivessel on-pump CABG during the same period. Perioperative data were prospectively collected and compared. In addition, univariate and risk-adjusted comparisons between the two groups were performed at 10 years.
Results:
After adjusting for clinical covariates, off-pump CABG did not emerge as a significant independent predictor of long-term mortality [hazard ratio (HR), 0.91; 95% confidence interval (CI), 0.70-1.12], readmission to hospital for cardiac cause (HR, 0.96; 95% CI, 0.78-1.10), or the need for reintervention (HR, 0.93; 95% CI, 0.87-1.05).
Conclusions:
At long-term follow-up, off-pump CABG remains a safe and effective myocardial revascularization strategy with no adverse impact on survival or freedom from reintervention.
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