Graft patency at 3 months after off- and on-pump coronary bypass surgery: a randomized trial

Sajja, Lokeswara Rao; Sarkar, Kunal; Mannam, Gopichand; Kodali, Venkata Krishna Kumar; Padmanabhan, Chandrasekar; Peter, Sanjeeth; Mulay, Anvay; Beri, Prashanthi

doi:10.1007/s12055-019-00869-0

Cited by 10 publications

(5 citation statements)

References 24 publications

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“…12 Similar to the current study, a multicentric randomised trial on 320 patients found that off-pump CABG was not inferior to on-pump CABG in terms of 3-month post-operative graft patency. 13 A study reported that off-pump CABG had a beneficial effect in terms of AKI. 14 The current study found 1 case of AKI in the on-pump group and no cases of AKI in the off-pump group, but this was not significantly different.…”

Section: Discussionmentioning

confidence: 99%

Off-pump versus on-pump coronary artery bypass grafting in patients with left main disease: a randomized controlled trial

et al. 2023

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Objective: To compare the outcome of off-pump and on-pump coronary artery bypass graft surgery in patients with left main coronary artery disease.Method: 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 graft surgery. 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).Conclusion: 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.Keywords: Coronary artery, Bypass, Myocardial infarction, Kidney, Diabetes, Myocardium, Pneumonia

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Section: Discussionmentioning

confidence: 99%

Off-pump versus on-pump coronary artery bypass grafting in patients with left main disease: a randomized controlled trial

et al. 2023

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“…We reported the graft patency outcomes and early clinical outcomes of the Prospective Randomized comparison of Off-pump and On-pump Multivessel coronary artery bypass surgery To Evaluate outcomes and graft patency (PROMOTE patency) trial previously. 6,7 The aim of the current study is to assess the 5-year clinical outcomes of OPCAB and ONCAB techniques in a post hoc analysis of the PROMOTE patency trial.…”

Section: Introductionmentioning

confidence: 99%

Five-year outcomes of off and on-pump CABG: Insights from PROMOTE Patency Trial

Sajja,

Sarkar,

Mannam

et al. 2023

Asian Cardiovasc Thorac Ann

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Background There are limited studies reporting follow-up outcome data comparing of off-pump coronary artery bypass (OPCAB) with on-pump (ONCAB) technique. The aim of the study was to report the 5-year clinical outcomes of OPCAB and ONCAB in a post hoc analysis of the PROMOTE patency trial. Methods From March 2016 through March 2017, a total of 321 patients undergoing coronary artery bypass grafting (CABG) were randomised to either the off-pump or the on-pump technique. Data on all-cause mortality, myocardial infarction (MI), cerebrovascular accident (CVA), repeat revascularisation and need for renal replacement therapy (RRT) were recorded. The composite and each of these individual outcomes are reported at 5-year interval. Results The mean follow-up period was 65.9 months (±3.39). A total of 275 (85.93%) patients followed up at the 5-year interval who underwent CABG by the off-pump ( n = 158) and the on-pump ( n = 162) technique. The all-cause mortality was 8.9% and 5.7% in ONCAB and OPCAB, respectively (hazard ratio [HR] = 0.62; 95% confidence interval [CI] 0.25–1.57, p = 0.31). The composite of all-cause mortality, non-fatal MI, non-fatal CVA, RRT and need for repeat revascularisation was comparable in both groups (7.1% vs. 11.9%, HR = 0.57; 95% CI 0.25–1.31, p = 0.18 in OPCAB and ONCAB, respectively). The rates of 5-year non-fatal MI ( p = 0.2), non-fatal CVA ( p = 0.36) and need for repeat revascularisation ( p = 1) were similar in both groups. A sub-group analysis did not show any significant interaction or effect modification with either of the techniques. Conclusions The 5-year clinical outcomes of OPCAB are comparable to ONCAB in low-risk patients undergoing CABG. Off-pump coronary artery bypass had no additional benefit in any subgroup.

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“…Some articles have reported that there was no difference in survival after off-pump versus on-pump or conventional CABG (22)(23)(24). Several recent articles have reported that there was no difference in patency between off-pump and on-pump CABG (25,26). However, it is doubtful whether it is appropriate to differentiate CABG into off-pump versus on-pump in evaluating graft patency, as on-pump beating CABG is technically similar to offpump CABG.…”

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confidence: 99%

Long-term patency of bilateral internal thoracic artery Y composite coronary artery bypass grafts—determinants and impact on survival

Chang¹,

Han²,

Park³

2022

J Thorac Dis

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Background: Bilateral internal thoracic artery Y-composite grafting with sequential anastomoses is a wellestablished strategy for multi-arterial coronary artery bypass grafting. This study investigated the factors affecting long-term patency of bilateral internal thoracic artery Y-composite grafts and their influence on survival.Methods: Patients who underwent coronary artery bypass grafting using bilateral internal thoracic artery Y-composite grafts due to triple-vessel disease were included. In total, 415 cases (2003In total, 415 cases ( -2020 with at least 1 postoperative coronary computed tomography or angiography examination were enrolled. Through a retrospective review of medical records and computed tomography, risk factors for graft events (string sign or occlusion) were analysed, and the influence of string sign or occlusion in the initial postoperative computed tomography on long-term survival was evaluated.Results: Patients' mean age was 66±9 years and 324 were male (78%). The mean number of anastomoses from bilateral internal thoracic artery grafts was 4.0±0.9. The mean follow-up duration was 8.0±4.0 years (interquartile range: 4.8-11.5 years). Beating-heart surgery negatively affected the patency of grafts to the left circumflex and right coronary artery territories (P=0.015 and P=0.030, respectively), but in the left anterior descending territory, the graft patency did not differ (P=0.053). Non-severe (<90%) native-vessel stenosis was a risk factor for poor patency in the left anterior descending, left circumflex, and right coronary artery territories (P<0.001 for all). Twenty-four of the 104 nonvisible or narrowed grafts (23%) on early imaging later became widely patent. Occlusion of the grafts or the string sign within postoperative 1 year did not have a negative impact on long-term survival (P=0.421). Conclusions:The patency rate was suboptimal in case of non-severe target-vessel stenosis (<90%). The beating-heart technique may negatively influence the patency of anastomoses to the left circumflex and right coronary artery territories. Compromised graft patency observed on initial computed tomography did not lead to worse survival.

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Graft patency at 3 months after off- and on-pump coronary bypass surgery: a randomized trial

Cited by 10 publications

References 24 publications

Off-pump versus on-pump coronary artery bypass grafting in patients with left main disease: a randomized controlled trial

Off-pump versus on-pump coronary artery bypass grafting in patients with left main disease: a randomized controlled trial

Five-year outcomes of off and on-pump CABG: Insights from PROMOTE Patency Trial

Long-term patency of bilateral internal thoracic artery Y composite coronary artery bypass grafts—determinants and impact on survival

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