On-pump versus off-pump coronary artery bypass surgery in high-risk patients: Operative results of a prospective randomized trial (on-off study)

Lemma, Massimo; Coscioni, Enrico; Tritto, Francesco Paolo; Centofanti, Paolo; Fondacone, Corrado; Salica, Andrea; Rossi, A; Santo, Tiziana De; Benedetto, Giuseppe Di; Piazza, L; Rinaldi, Mauro; Schinosa, Luigi de Luca Tupputi; Paulis, Ruggero De; Contino, Monica; Genoni, Michele

doi:10.1016/j.jtcvs.2011.11.011

Cited by 100 publications

(65 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A study conducted by Lemma on CABG in high-risk patients indicated that mortality, myocardial infarction, stroke, and renal failure following OPCAB are lower than CCABG surgery. 6) This evidence was in line with our study about postoperative renal failure but was different from postoperative mortality and major postoperative morbidity, such as myocardial infarction and stroke. The reason for this difference can be the limited sample size, since our study only included 90 CCABG and 90 OP-CAB patients.…”

Section: Discussionsupporting

confidence: 88%

“…5) A multicenter, prospective, randomized, parallel trial reported that OP-CAB reduced early mortality and morbidity in high-risk patients. 6) On the contrary, another randomized clinical trial demonstrated that mortality seemed higher after off-pump CABG; in addition, no significant difference in major adverse cardiac and cerebrovascular events was found between OP-CAB and CCABG in patients with a high-risk operative profile. 7) Whether OPCAB is better or not at reducing early mortality and postoperative morbidities in high-risk patients as compared to CCABG remains to be confirmed.…”

mentioning

confidence: 97%

See 1 more Smart Citation

On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in High-Risk Patients

Mei

Wang

et al. 2014

Int. Heart J.

View full text Add to dashboard Cite

SummaryThis study aimed to evaluate on-pump versus off-pump coronary artery bypass grafting (CABG) in patients with a high-risk operative profile.The pre-, intra-and post-operative data of high-risk patients with additive European system for cardiac operative risk evaluation (additive Euro-SCORE) over 6 undergoing isolated CABG from January 2008 to December 2011 in this center were investigated and retrospectively analyzed. Using the propensity score-matching method, those patients with similar pre-and intra-operative characteristics were selected and their early clinical outcomes were compared.From January 2008 to December 2011, 485 consecutive patients (398 males, with a mean age of 70.9 ± 9.0 years) whose additive Euro-SCORE was over 6 were entered into this study. Off-pump coronary bypass grafting (OPCAB) was performed in 58.1% (n = 282), and the remaining patients underwent conventional coronary artery bypass grafting (CCABG). After propensity score matching, the two groups of patients (90 OPCAB patients versus 90 CCABG patients) were similar with regard to pre-and intra-operative characteristics but not duration of surgical procedure. No significant differences in hospital mortality were found. Compared to CCABG, high-risk patients undergoing OPCAB had significantly lower prevalence of postoperative respiratory failure and postoperative renal failure (6.7% versus 17.8%, P = 0.0386, 5.6% versus 16.7%, P = 0.0307, respectively). Through multivariate logistic regression analysis, type of procedure (CCABG versus OPCAB), as an independent risk factor, had an impact on the postoperative respiratory failure (OR = 2.36, 95%CI 1.44-4.97, P = 0.0312) and postoperative renal failure (OR = 2.86, 95%CI 1.61-5.81, P = 0.0037).Compared with CCABG, OPCAB reduced postoperative respiratory and renal morbidity in high-risk patients. (Int Heart J 2014; 55: 484-488)

show abstract

Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 97%

On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in High-Risk Patients

Mei

Wang

et al. 2014

Int. Heart J.

View full text Add to dashboard Cite

show abstract

“…Additionally, the lower additive EuroSCORE in the BBS Trial (mean 6.9) compared to the PRAGUE 6 trail (mean > 7.5) suggests that we generally enrolled more seriously ill patients 15 . Lemma´s randomized study is the trial most similar to ours; they also found a significant reduction in serious early post-operative complications in the off-pump group, although the primary combined end-point was defined in a slightly different way with the addition of reoperation for bleeding and acute respiratory distress syndrome 16 . In the first 30 days we observed a significantly lower incidence of non-fatal MI in the off-pump group.…”

Section: Early Outcomessupporting

confidence: 64%

Off-pump versus on-pump coronary artery bypass grafting surgery in high-risk patients: PRAGUE-6 trial at 30 days and 1 year

Hlavicka¹,

Straka²,

Jelínek³

et al. 2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

Aims. Off-pump coronary artery bypass graft surgery (OPCAB) is an established alternative to on-pump surgical revascularization. Previous studies in patients with low or intermediate risk showed no significant differences between off-pump and on-pump surgical revascularization. The aim of this study was to compare the two techniques in patients with high operative risk. Methods. PRAGUE-6 is a prospective randomized single-center study of 206 patients, with an additive EuroSCORE ≥ 6, scheduled for isolated coronary surgery: Group A -on-pump (n = 108) versus Group B -off-pump (n = 98). The primary outcome was a combined endpoint of all-cause deaths, stroke, myocardial infarction, or renal failure requiring new hemodialysis, within 30 days and 1 year after randomization. All data were analyzed using the "intention-to-treat" principle. Results. Early postoperative myocardial infarction was detected in 12.1% (A) vs. 4.1% (B) of patients (P = 0.048, hazard ratio 0.32, 95% CI 0.11-0.99). There was a significantly higher incidence of primary combined end-point in group A (20.6% vs. 9.2%, P = 0.028, HR 0.41, 95% CI 0.19-0.91) in the first 30 days, but not after 1 year (30.8% vs. 21.4%, P = 0.117, HR 0.65, CI 0.37-1.12). Conclusion. Off-pump surgical revascularization in patients with high operative risks can significantly reduce the incidence of major postoperative complications during the first 30 days. There was no statistically significant difference in the incidence of these complications after 1 year.

show abstract

“…The most notable merits, as suggested by several observational studies, included avoiding embolic stroke caused by invasive aortic manipulation and reducing coagulopathy and renal dysfunction (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). However, the expected benefit on long term survival is still debated.…”

Section: Discussionmentioning

confidence: 99%

“…This has triggered a large number of randomized clinical trials (RCTs) and retrospective analyses addressing the clinical outcomes of the two techniques. There seems to be convincing evidence that OPCAB reduces the risk of early postoperative morbidity such as myocardial infarction, pulmonary dysfunction, abnormal renal function, atrial fibrillation, blood product transfusion, intensive care unit and hospital stay (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). However, concerns persist with respect to the impact of OPCAB on long-term mortality…”

Section: Introductionmentioning

confidence: 99%

Impact of off-pump coronary artery bypass grafting on survival: current best available evidence

et al. 2016

View full text Add to dashboard Cite

Abstract:The superiority of either off-pump (OPCAB) or on-pump (ONCAB) coronary artery bypass grafting (CABG) remains unclear despite a large body of literature evidence comparing the two approaches.The potential advantages of avoiding cardiopulmonary bypass (CPB), minimizing aortic manipulation and maintaining pulsatile flow may be associated with reduced inflammatory responses and embolic events.Numerous studies compared OPCAB with ONCAB and the cumulative data have been presented in metaanalyses of both randomized and observational studies. Although there is an abundance of data with respect to the operative morbidity and mortality and the short-term outcomes associated with these two strategies, not much is known about how they impact long-term survival and recurrence of myocardial ischaemic events. Recent studies and meta-analyses have focused on long-term survival and major secondary outcomes in OPCAB vs. ONCAB within the general population. Significant limitations in methodology, however, have raised concerns about the strength of several randomized trials with restrictive inclusion criteria that reduced the populations to those at low risk only, thus creating result bias. Here, we present a review of the best available evidence with a focus on long-term outcomes.

show abstract

On-pump versus off-pump coronary artery bypass surgery in high-risk patients: Operative results of a prospective randomized trial (on-off study)

Abstract: Off-pump coronary artery bypass grafting reduces early mortality and morbidity in high-risk patients.

Cited by 100 publications

References 14 publications

On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in High-Risk Patients

On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in High-Risk Patients

Off-pump versus on-pump coronary artery bypass grafting surgery in high-risk patients: PRAGUE-6 trial at 30 days and 1 year

Impact of off-pump coronary artery bypass grafting on survival: current best available evidence

Contact Info

Product

Resources

About