On-Pump versus Off-Pump Coronary-Artery Bypass Surgery

Shroyer, A. Laurie; Grover, Frederick L.; Hattler, Brack G.; Collins, Joseph F.; McDonald, Gerald O.; Kozora, Elizabeth; Lucke, John C.; Baltz, Janet H.; Novitzky, D.

doi:10.1056/nejmoa0902905

Cited by 998 publications

(632 citation statements)

References 31 publications

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“…Although a recent prospective randomized trial identified OPCAB to have no advantage in low-risk patients [16], it appears to be the superior method of revascularization in high-risk patients [9,17,18].…”

Section: Discussionmentioning

confidence: 99%

Off-pump surgery for the poor ventricle?

et al. 2011

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Severely decreased ejection-fraction is an established risk-factor for worse outcome after cardiac surgery. We compare outcomes of off-pump coronary artery bypass grafting (OPCAB) and on-pump CABG (ONCABG) in patients with severely compromised EF. From 2004 to 2009, 478 patients with a decreased EF B35% underwent myocardial-revascularization. Patients received either OPCAB (n = 256) or ONCABG (n = 222). Propensity score (PS), including 50 preoperative risk-factors, was used to balance characteristics between groups. PS adjusted logistic regression analysis was performed to assess mortality and major adverse cardiac and cerebrovascular events (MACCE). A composite endpoint for major non-cardiac complications such as respiratory failure, renal failure, rethoracotomy was applied. Complete revascularization (CR) was assumed when the number of distal anastomoses was larger than that of diseased vessels. There was no difference for mortality (2.3 vs. 4.1%; PS-adjusted odds ratio (PS-OR) = 1.05; p = 0.93) and MACCE (13.7 vs. 17.6%; PS-OR = 1.22; p = 0.50) including myocardial-infarction (1.4 vs. 4.9%; PS-OR = 0.39; p = 0.26), low cardiac output (2.3 vs. 4.7%; PS-OR = 0.75; p = 0.72) and stroke (2.3 vs.2.7%; PS-OR = 0.69; p = 0.66). OPCAB patients presented with a trend to less frequent occurrence of the non-cardiac composite (12.1 vs. 22.1%; PS-OR = 0.54; p = 0.059) including renal dysfunction (PAOR = 0.77; 95% CI 0.31-1.9; p = 0.57), bleeding (PAOR = 0.42; 95% CI 0.14-1.20; p = 0.10) and respiratory failure (PAOR = 0.39; 95% CI 0.05-3.29; p = 0.39). The rate of complete revascularization was similar (92.2 vs. 92.8%; PS-OR = 0.75; p = 0.50). OPCAB in patients with severely decreased EF is safe and feasible. It may even benefit these patients in regard to non-cardiac complications and does not come at cost of less complete revascularization.

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Section: Discussionmentioning

confidence: 99%

Off-pump surgery for the poor ventricle?

et al. 2011

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“…In CORONARY,27 the primary composite outcome of death, nonfatal stroke, or nonfatal myocardial infarction (MI) was similar between OPCAB and ONCAB (9.8% versus 10.3%, P =0.59). Similarly in ROOBY, the primary composite outcome of 30‐day death or major complications was similar between the 2 arms (7.0% versus 5.6%, P =0.19) 38. Furthermore, there was no difference in any individual component of these early composite outcomes (Table 1).…”

Section: Comparison Of Short‐term Clinical Outcomes Of On‐ and Off‐pumentioning

confidence: 80%

“…In the largest randomized comparisons (CORONARY [CABG Off or On Pump Revascularization] and ROOBY [Randomized On/Off Bypass] trials), there were no differences in the primary study end point at 30 days 27, 38. In CORONARY,27 the primary composite outcome of death, nonfatal stroke, or nonfatal myocardial infarction (MI) was similar between OPCAB and ONCAB (9.8% versus 10.3%, P =0.59).…”

Section: Comparison Of Short‐term Clinical Outcomes Of On‐ and Off‐pumentioning

confidence: 99%

Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

Gaudino

Angelini

Antoniades

et al. 2018

JAHA

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“…Наибо-лее информативные рандомизированные исследования включали как пациентов с относительно невысоким риском вмешательства (ROOBY), так и больных стар-ше 75 лет со значительно худшими характеристиками (GOPCABE). Эти исследования, как и большинство ме-таанализов, продемонстрировали, что ранние и годич-ные результаты КШ off-pump сравнимы с результатами стандартных операций, однако в группах off-pump от-мечена большая неполная реваскуляризация, необхо-димость повторных вмешательств и худшая проходи-мость шунтов [44,45]. Недавно опубликованная работа B.H.…”

Section: тактика операцииunclassified

Modern trends in coronary surgery

Акчурин¹,

Shiryaev²,

Vasiliev³

et al. 2017

PKiK

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Based on their 30-year experience, the authors discuss the most important problems in coronary surgery. The modern view on the indications for surgery, as well as on patients selection is presented in the light of the most recent and complete studies. The authors also present the modern approach to surgical technique, choice of graft and describe opportunities offered by microsurgical technique.Received 30 June 2017. Accepted 10 July 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interests.

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On-Pump versus Off-Pump Coronary-Artery Bypass Surgery

Cited by 998 publications

References 31 publications

Off-pump surgery for the poor ventricle?

Off-pump surgery for the poor ventricle?

Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

Modern trends in coronary surgery

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