What is the clinical evidence from this study?

Study design: RCT. Population: Stable angina pectoris (n=120). Intervention: Off-pump coronary artery bypass surgery vs. On-pump coronary artery bypass surgery. Primary outcome: Vein graft patency at 3 months (p=.11).

January 4, 2005Open Access

Clinical and Angiographic Outcome of Coronary Surgery with and without Cardiopulmonary Bypass: A Prospective Randomized Trial

Resultado clave

Off-pump coronary artery bypass surgery resulted in similar 3-month vein graft patency (83% vs 91%, p=0.11) and internal mammary artery patency (98% in both groups) compared to on-pump surgery.

Diseño del estudio

Tipo

RCT (n=120)

Aleatorización

Blocks of 20

Multicéntrico

PICO estructurado

Does off-pump coronary artery bypass surgery provide comparable perioperative outcomes and short-term graft patency to on-pump surgery in patients with stable angina?

Población

120 patients with stable angina pectoris and moderate or good left ventricular function eligible for coronary artery bypass surgery. Mean age 64-65 years. Exclusions: ejection fraction <30% and/or renal failure (serum creatinine >200 mmol/L).

Intervención

Off-pump coronary artery bypass surgery (n=60)

Comparador

On-pump coronary artery bypass surgery with cardiopulmonary bypass (n=60)

Resultado

Perioperative morbidity and mortality, and intraoperative and short-term (3 months) graft patencycomposite

Off-pump coronary artery bypass surgery provides comparable perioperative outcomes and short-term graft patency to traditional on-pump surgery in patients with stable angina and preserved ventricular function.

Resultado numérico

Tasa de eventos absoluta: 83% vs 91%

valor p: p=.11

Limitaciones

Seven procedures were converted from off-pump to on-pump surgery, which may have influenced bleeding and operation time results despite intention-to-treat analysis.
In the first 40 cases, patients with significant lesions of the circumflex artery were excluded due to limitations of the angiography table.
The sample size was too small to detect statistically significant differences in rare clinical events such as stroke.

Resumen

Abstract Background: Off-pump coronary artery bypass surgery has emerged as an alternative technique to traditional onpump surgery. The aim of this randomized study was to compare perioperative morbidity and mortality and intraoperative and short-term graft patency in off-pump and on-pump coronary artery bypass grafting. Methods: One hundred twenty patients were randomized for coronary revascularization with or without cardiopulmonary bypass. In all patients grafts and anastomoses were monitored with transit time Doppler ultrasonography and angiography. Angiography was repeated 3 months after the procedure in 115 of the patients. Results: Angiography 3 months postoperatively revealed that internal mammary artery patency was 98% in both groups. Vein graft patency was 83% in the off-pump group and 91% in the on-pump group, a difference that was not statistically significant. One perioperative death was recorded in each group. Two strokes were recorded in the on-pump group, none in the off-pump group. Conclusion: In this prospective, controlled study, perioperative and short-term outcome of off-pump coronary surgery equaled that of on-pump surgery.

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