Key result
On-pump CABG shows no benefit over off-pump surgery for ventilation time or fast-track failure.
Why the study?
The study was conducted to compare patients undergoing on-pump versus off-pump coronary artery bypass surgery managed with a fast-track protocol.
Does on-pump coronary artery bypass surgery improve ventilation time and fast-track failure rates compared to off-pump surgery in patients managed with a fast-track protocol?
Observational (n=1,852)
No
Does on-pump coronary artery bypass surgery improve ventilation time and fast-track failure rates compared to off-pump surgery in patients managed with a fast-track protocol?
On-pump and off-pump CABG are comparable regarding ventilation time and fast-track failure in a fast-track protocol setting, though they differ in postoperative blood loss and transfusion requirements.
Answers are grounded in this paper and cite their sources.
Similar fast-track outcomes support either on- or off-pump CABG; leaves open randomized trials on bleeding and long-term endpoints.
The purpose of this study was to compare patients who underwent on- vs. off-pump coronary artery bypass surgery managed with a fast-track protocol. Between September 2012 and December 2018, n = 3505 coronary artery bypass surgeries were managed with a fast-track protocol in our specialized post-anesthesia care unit. Propensity score matching was applied and resulted in two equal groups of n = 926. There was no significant difference in ventilation time (on-pump 75 (55–120) min vs. off-pump 80 (55–120) min, p = 0.973). We found no statistically significant difference in primary fast-track failure in on-pump (8.2% (76)) vs. off-pump (6% (56)) groups (p = 0.702). The secondary fast-track failure rate was comparable (on-pump 12.9% (110) vs. off-pump 12.3% (107), p = 0.702). There were no significant differences between groups in regard to the post-anesthesia care unit, the intermediate care unit, and the hospital length of stay. Postoperative outcome and complications were also comparable, except for a statistically significant difference in PACU postoperative blood loss in on-pump (234 mL) vs. off-pump (323 mL, p < 0.0001) and red blood cell transfusion (11%) and (5%, p < 0.001), respectively. Our results suggest that on- and off-pump coronary artery bypass surgery in fast-track settings are comparable in terms of ventilation time, fast-track failure rate, and postoperative complications rate.
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Grützner et al. (2021) conducted an observational in Coronary artery disease requiring bypass grafting (n=1,852). On-pump coronary artery bypass surgery vs. Off-pump coronary artery bypass surgery was evaluated on Mechanical ventilation time (p=0.973). On-pump coronary artery bypass surgery showed no significant difference compared to off-pump surgery in mechanical ventilation time (75 vs. 80 minutes, p=0.973) or primary fast-track failure (8.2% vs. 6.0%, p=0.702).
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