Off-pump Versus On-pump Coronary Artery Bypass Surgery: Graft Patency Assessment With Coronary Computed Tomographic...

Area of Science:

• Cardiovascular Surgery
• Medical Imaging

Background:

• Coronary artery bypass grafting (CABG) is a common surgical procedure.
• Assessing graft patency is crucial for long-term outcomes.
• Off-pump CABG aims to avoid cardiopulmonary bypass, but its graft patency compared to on-pump CABG requires further evaluation.

Purpose of the Study:

• To compare graft patency between off-pump and on-pump coronary artery bypass grafting (CABG) in a prospective multicenter pilot study.
• To assess the feasibility of conducting a large randomized trial (RCT) on CABG techniques.
• To evaluate the reliability of computed tomography angiography for assessing graft patency post-CABG.

Main Methods:

• Prospective recruitment of 157 patients undergoing either off-pump or on-pump CABG across 3 centers.
• Graft patency assessed 1 year post-surgery using ≥64-slice computed tomography angiography.
• Blinded assessment categorized patency as normal, ≥50% stenosis, or occlusion; multilevel modeling was used.

Main Results:

• The overall graft patency index was 89% for off-pump and 95% for on-pump CABG (P=0.09).
• No significant differences in patency were observed between arterial and vein grafts (92% for both).
• Graft patency was comparable across different target territories.

Conclusions:

• One-year graft patency rates were similar for both off-pump and on-pump CABG in this pilot study.
• The study demonstrates the feasibility of a large multicenter RCT to compare CABG techniques.
• Computed tomography angiography is a reliable tool for assessing CABG graft patency in large trials.