Off-Pump Versus On-Pump Coronary Artery Bypass Grafting In Patients With Left Main Coronary Artery Disease: A
Karim Mohamed Mady1, Amr Ahmed Abdou Ettish1, Wael Mohamed Elfeky1
1Department of Cardiothoracic Surgery, Kafrelsheikh University,Egypt.
Insights
Off-pump coronary artery bypass graft surgery is as effective as on-pump surgery for left main coronary artery disease. This study found no significant difference in outcomes between the two surgical approaches.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Procedures
Background:
- Left main coronary artery disease (LMCA) poses significant risks.
- Coronary artery bypass graft (CABG) surgery is a primary treatment for LMCA.
- Comparing on-pump (traditional) and off-pump (minimally invasive) CABG is crucial for patient outcomes.
Purpose of the Study:
- To compare the efficacy and safety of off-pump versus on-pump coronary artery bypass graft surgery.
- To evaluate post-operative complications and mortality in patients with LMCA disease undergoing different CABG techniques.
Main Methods:
- A prospective, randomized, controlled, multicenter study conducted in Egypt from January to December 2020.
- Sixty patients with LMCA disease were randomized into two groups: on-pump CABG (Group I) and off-pump CABG (Group II).
- Post-operative assessments included myocardial infarction, acute kidney injury, pneumonia, sternal dehiscence, and 3-month mortality.
Main Results:
- No significant differences were observed in the incidence of myocardial infarction, acute kidney injury, pneumonia, sternal dehiscence, or 3-month mortality between the on-pump and off-pump groups.
- The on-pump group had 2 cases of myocardial infarction and 1 case of acute kidney injury, while the off-pump group had 1 case of myocardial infarction and no acute kidney injury.
- Pneumonia occurred in 10% of the on-pump group versus 3.3% in the off-pump group, and sternal dehiscence in 3.3% of the on-pump group versus none in the off-pump group.
Conclusions:
- Off-pump coronary artery bypass graft surgery is an efficient and non-inferior alternative to the on-pump procedure for patients with left main coronary artery disease.
- Both surgical techniques demonstrated comparable safety profiles regarding major post-operative complications and short-term mortality.
Objectives:
To compare the outcome of off-pump and on-pump coronary artery bypass graftsurgery in patients with left main coronary artery disease.
Methods:
The randomised, controlled, prospective, multicentric study was conducted in 2020 during the period from January 2020 to December 2020 at Kafrelsheikh University Hospital, International Cardiac Centre and Alexandria New Medical Centre, Egypt, and comprised patients with left main coronary artery disease who underwent coronary artery bypass graftsurgery. The patients were randomised to on-pump surgery group I (Control Group) and off-pump surgery group II(Interventional Group). All patients were assessed pre-operatively for the presence of comorbid conditions and post-operatively for myocardial infarction, acute kidney injury, pneumonia, sternal dehiscence and 3-month mortality. Data was analysed using SPSS 20.
Results:
Of the 60 patients, 44(73.3%) were men and 16(26.6%) were women. The overall mean age was 66.4±9.2 years. There were 30(50%) patients in each of the two groups. There were 2(6.7%) cases of myocardial infarction in group I and 1(3.3%) in group II. There was 1(3.3%) case of acute kidney injury in group I and none in group II. There were 3(10%) cases of pneumonia in group 1 compared to 1(3.3%) in group II. There was 1(3.3%) case of sternal dehiscence in group I and none in group II. Mortality at 3 months was 2(6.7%) in group I and 1(3.3%) in group II. There was no significant difference with respect to outcome between the groups (p>0.05).
Conclusions:
Off-pump coronary artery bypass graft surgery was found to be efficient and non-inferior to on-pump procedure in patients with left main coronary artery disease.
Rct Registration:
The RCT was registered retrospectively at the Pan African Clinical Trials Registry (PACTR) (Trial #: PACTR202301506140749 Date of Approval: 06/01/2023). Link: https://pactr.samrc.ac.za/Search.aspx.
