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Published on: March 27, 2018
Long-Term Survival After Off-Pump Coronary Artery Bypass Grafting
Bilal H Kirmani1, Andrew Brazier1, Sanjeevan Sriskandarajah1
1Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
Insights
Off-pump coronary artery bypass grafting (CABG) offers comparable long-term survival to on-pump CABG. This approach also shows reduced cerebrovascular complications and shorter hospital stays, highlighting its potential benefits for cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Anesthesia
Background:
- Coronary artery bypass grafting (CABG) is a critical intervention for coronary artery disease.
- Two primary techniques exist: off-pump CABG and on-pump CABG using cardiopulmonary bypass.
- Long-term survival outcomes between these techniques require continued investigation.
Purpose of the Study:
- To compare the long-term survival rates of isolated first-time coronary artery bypass grafting (CABG) between off-pump and on-pump techniques.
- To evaluate in-hospital morbidity and long-term all-cause mortality.
- To identify differences in complication rates and resource utilization.
Main Methods:
- A retrospective analysis of 8,055 patients undergoing isolated CABG between 2000 and 2014 at a single center.
- Propensity score matching was utilized to balance patient demographics.
- Comparison of in-hospital morbidity, long-term all-cause mortality, and length of stay.
Main Results:
- No significant difference in long-term survival was observed between off-pump and on-pump CABG groups (11.5 vs 11.3 years, p=0.178).
- Off-pump CABG demonstrated significantly fewer in-hospital cerebrovascular complications (0.5% vs 1.1%, p=0.017) and a shorter mean length of stay (7.6 vs 8.1 days, p<0.0001).
- Higher arterial conduit use, including right mammary artery and sequential grafts, was noted in the off-pump group.
Conclusions:
- Off-pump CABG provides comparable long-term survival to on-pump CABG.
- The reduction in cerebrovascular complications may be attributed to conduit selection and minimized aortic manipulation.
- Off-pump CABG presents a viable alternative with potential advantages in specific patient outcomes.
Background:
The aim of this study was to compare the long-term survival rates of patients undergoing isolated first-time coronary artery bypass grafting (CABG) by off-pump CABG with the long-term survival rates in patients undergoing CABG using cardioplegic cardiopulmonary bypass techniques.
Methods:
All patients undergoing isolated CABG at a single center (Manchester Heart Centre, Manchester, United Kingdom) between 2000 and 2014 were included. Propensity score matching was performed on the basis of on demographic variables. The in-hospital morbidity and long-term all-cause mortality rates for matched patients were compared.
Results:
A total of 8,055 patients were identified, with a median follow-up of 7.0 years. With patients matched for preoperative patient characteristics, there was no significant difference in long-term survival between cardiopulmonary bypass and off-pump CABG (n = 2,082 each; 11.5 years vs 11.3 years; p = 0.178). In the off-pump CABG group, there were significantly fewer in-hospital cerebrovascular complications (0.5% vs 1.1%; p = 0.017), and mean length of stay was shorter (7.6 days vs 8.1 days; p < 0.0001). Arterial conduit use was significantly higher in the off-pump group, with more right mammary artery grafts (16.3% vs 4.3%; p < 0.0001) and sequential grafts (27.1% vs 13.5%; p < 0.0001). The mean number of grafts was higher in the on-pump group (3.28 ± 0.94 vs 3.10 ± 1.10; p < 0.0001).
Conclusions:
Long-term survival after off-pump CABG is not inferior to long-term survival after on-pump CABG despite a lower mean number of grafts. A statistically significant difference in cerebrovascular complications may be related to conduit choice and reduced aortic manipulation.
