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Published on: March 27, 2018
Graft patency at 3 months after off- and on-pump coronary bypass surgery: a randomized trial
Lokeswara Rao Sajja1,2, Kunal Sarkar3, Gopichand Mannam1
1Division of Cardiothoracic Surgery, STAR Hospitals, Road no. 10, Banjara Hills, Hyderabad, Telangana 500 034 India.
Insights
Off-pump coronary artery bypass grafting (CABG) shows non-inferior graft patency compared to on-pump CABG at 3 months. This off-pump technique also resulted in fewer major adverse cardiac and cardiovascular events.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for multivessel coronary artery disease.
- CABG can be performed on-pump using cardiopulmonary bypass or off-pump without it.
- Limited angiographic data exists comparing the long-term graft patency of off-pump versus on-pump CABG.
Purpose of the Study:
- To ascertain the non-inferiority of off-pump CABG compared to on-pump CABG.
- To evaluate angiographically assessed graft patency at 3 months post-procedure.
- To compare major adverse cardiac and cardiovascular events (MACCE) between the two surgical techniques.
Main Methods:
- A multicenter prospective randomized trial included 320 patients with multivessel coronary artery disease.
- Patients were randomized to either on-pump CABG (n=162) or off-pump CABG (n=158).
- Graft patency was assessed at 3 months using multidetector computerized tomographic angiography or conventional coronary angiography.
Main Results:
- Overall graft patency at 3 months was similar between on-pump (87.6%) and off-pump (87.1%) groups (p=0.82).
- The off-pump group experienced significantly fewer cumulative MACCE (0.63%) compared to the on-pump group (5.55%) (p=0.01).
- No significant difference in 3-month mortality was observed between the groups.
Conclusions:
- Off-pump CABG is non-inferior to on-pump CABG regarding 3-month graft patency.
- The off-pump technique demonstrated a significant reduction in combined MACCE.
- These findings support the efficacy and safety of off-pump CABG.
Purpose:
Coronary artery bypass grafting (CABG) is performed either with the aid of cardiopulmonary bypass (on-pump) or without cardiopulmonary bypass (off-pump). There is a scarcity of angiographic data to support the non-inferiority of off-pump technique to on-pump technique. The objective of this study is to ascertain the non-inferiority of off-pump CABG when compared to on-pump CABG in terms of angiographically assessed graft patency at 3 months.
Methods:
A total of 320 patients with multivessel coronary artery disease were enrolled in a multicenter prospective randomized trial either to on-pump CABG (n = 162) or off-pump CABG (n = 158) between March 2016 through March 2017. Graft patency was evaluated by using either multidetector computerized tomographic angiography or conventional coronary angiography at 3 months. The major adverse cardiac and cardiovascular events (MACCE) were also analyzed at 3 months.
Results:
The median number of grafts per patient in off-pump was 3.00 (Q1:3.00 and Q3:4.00) vs on-pump 4.00 (Q1:3.00 to Q3:4.00), and the mean number of grafts per patient was lower in the off-pump CABG at 3.45 ± 0.75 vs 3.64 ± 0.70 in the on-pump CABG (p = 0.01). There was no significant difference in mortality at 3 months between the off-pump (0.63%) and on-pump groups (1.85%) with p value of 0.62. The cumulative combined MACCE showed significant difference between off-pump group (0.63%) and on-pump group (5.55%), p = 0.01. Follow-up angiograms were done in 239 (75%) patients with 120 off-pump and 119 in the on-pump group. The analysis was also done regarding graft patency in a graded manner-when analysis of A (excellent) grafts vs B (stenosed) grafts and O (occluded) grafts were made, there was no statistically significant difference in overall graft patency at 3 months between on-pump [376 /429 grafts (87.6%)] and off-pump [366 /420 grafts (87.1%)] groups (p = 0.82). The patency rates were similar among bypass conduits (left internal thoracic artery (ITA) in off-pump (91.4%) vs on-pump (92.9%) p = 0.66, right ITA in off-pump (82.1%) vs on-pump (81.8%) p = 0.97, radial artery in off-pump (84.4%) vs on-pump (82.6%) p = 0.81; saphenous vein in off-pump (85.8%) vs on-pump (86.3%), p = 0.86 and among 3 coronary territories.
Conclusions:
Off-pump CABG is non-inferior to on-pump CABG in terms of overall graft patency at 3 months and was associated with a fewer combined cumulative MACCE compared to on-pump CABG.
