What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary artery disease (n=302). Intervention: Off-pump coronary artery bypass grafting vs. On-pump coronary artery bypass grafting. Primary outcome: Long-term mortality (HR 1.242, 95% CI 0.676-2.281, p=0.485).

What question did this study set out to answer?

This research aims to compare long-term outcomes between off-pump and on-pump coronary artery bypass grafting.

June 12, 2019Open Access

Long Term Outcomes of The Off-Pump and On-Pump Coronary Artery Bypass Grafting In A High-Volume Center

Key Result

Off-pump coronary artery bypass grafting showed no significant difference in long-term survival compared to on-pump surgery in a propensity-matched analysis.

Key Points

This research aims to compare long-term outcomes between off-pump and on-pump coronary artery bypass grafting.
Performed propensity matched study of 302 CABG patients, including 143 off-pump cases.
Five-year follow up with data on mortality, rehospitalization, myocardial infarction, and cerebrovascular accidents.
Matched high-risk off-pump patients with lower-risk on-pump patients for analysis.
No significant difference in long-term survival between off-pump and on-pump groups.
Comparable rates of major adverse cardiac and cerebrovascular events (MACCE) were observed.
Fewer differences noted after matching, indicating off-pump is viable for high-risk patients.

Study Design

Type

Cohort (n=302)

Multicenter

Structured PICO

Does off-pump coronary artery bypass grafting improve long-term survival compared to on-pump coronary artery bypass grafting in patients undergoing isolated CABG?

Population

302 patients subjected to isolated CABG during 2012-2013 (143 off-pump, 159 on-pump)

Intervention

Off-pump coronary artery bypass grafting (OPCAB) performed by experienced surgeons

Comparator

On-pump coronary artery bypass grafting (CPB) performed by experienced surgeons

Outcome

Long-term survivalhard clinical

In experienced hands, off-pump CABG offers comparable long-term survival to on-pump CABG, even when applied to a higher-risk patient population.

Main Result

Effect estimate: HR 1.242 (95% CI 0.676-2.281)

Absolute Event Rate: 20.3% vs 13.3%

p-value: p=0.485

Limitations

Observational study design limited by the number of patients
Decision on the type of CABG was left to the surgeon's preference
Graft patency was not examined angiographically, relying instead on the rate of repeated revascularization

Abstract

Coronary artery bypass grafting (CABG) remains the most frequent surgery in the practice of an adult cardiac surgeon and the most frequently performed cardiac surgical procedure worldwide. Despite the ongoing debates regarding the superiority or inferiority of off-pump coronary artery bypass grafting, it still comprises 15-30% of all CABG cases varying in different national registries. We performed a propensity matched study of 302 consecutive CABG patients,143 off -pump cases performed by the four experienced off-pump surgeons and the on-pump CABG cases performed by those surgeons and four other experienced coronary surgeons. The five year follow up was performed and data collected comprised of mortality, rehospitalization due to cardiac origin, repeated revascularization, myocardial infarction and cerebrovascular accident. Overall, the off-pump group of patients had a higher risk profile than the patients in the on-pump group. After matching, fewer differences were found between the groups. Propensity score matching analysis showed no difference in long-term survival as well as MACCE and repeated revascularization. The higher risk profile of the patients subjected to OPCAB and the comparable survival to lower risk CPB patients in this series indicate that in experienced hands, OPCAB is a valuable option in this important subgroup of patients.

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