Off-Pump vs Conventional Coronary Artery Bypass Grafting: Early and 1-Year Graft Patency, Cost, and Quality-of-Life Outcomes

Abstract

OTIVATED BY MORBIDITY attributable to cardiopulmonary bypass, 1-3 US surgeons performed approximately 21% of coronary artery bypass operations off-pump in 2002. 4 Nonetheless, concern remains about the technical difficulty of off-pump coronary artery bypass (OPCAB), including the possibility of imprecise anastomoses and incomplete revascularization compromising patient outcomes. 5-9 Two prospective, randomized studies 10,11 and all but a few 12 retrospective comparisons have reported significantly fewer grafts in OPCAB. Retrospective studies among selected patients showing sig

Current Evidence of On-Pump Versus Off-Pump Coronary Artery By-Pass Surgery

“…Several studies compared the number of grafts compared to a preoperative plan. In most of these studies, no difference was found (8)(9)12,14,23), a few studies showed a difference in favour of CCABG, and one study found a difference in favour of OPCAB (24). In this study, however, the absolute number of grafts was 0.2 lower in the OPCAB-group.…”

“…Five years postoperatively 130/142 OPCAB-patients and 130/139 CCABG patients were alive (p=ns). Other studies with up to twelve months follow-up also failed to show any difference (7)(8)(9)(10)(11)(12)(13). Due to the relatively low risk of mortality associated with either operation, however, the statistical strength to detect any difference is not present in any of these studies.…”

“…This difference, however, did not result in a higher number of myocardial infarctions in the OPCAB group. In studies performed by few, dedicated OPCAB surgeons, the difference in number of grafts was very small and not statistically significant (12,24). The study by Khan (25), the SMART study (14), and the Best Bypass Surgery Study (26) differentiated the findings and found a higher proportion of occluded grafts at right and circumflex territories and fewer occlusions in the LAD territory.…”

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“…Additionally, a smaller fraction of OPCAB patients require inotropic or intra-aortic balloon pump support when compared to their propensity-matched CABG counterparts. A marked decrease in the need for transfusion of blood, platelets and fresh frozen plasma has also been noted (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34).…”

“…Observational studies have demonstrated a significant increase in both retinal and cerebral microemboli following CPB (43-45). CPB has also been associated with increased cerebral emboli, inflammation and water content (43,(46)(47)(48) A randomized prospective trial comparing the results of OPCAB and CABG performed by a single, highly experienced surgeon demonstrated equivalent graft patency by coronary angiography at both initial discharge and 1 year following revascularization (34). Similarly, Nathoe and colleagues demonstrated equivalent graft patency between CABG and OPCAB 1 year following revascularization (60).…”