What question did this study set out to answer?

To evaluate the efficacy of revascularization and immediate outcomes in off-pump versus on-pump CABG using microsurgical techniques.

April 4, 2026Open Access

Effectiveness of revascularization and immediate outcomes after off-pump coronary artery bypass surgery using microvascular techniques and surgical microscope. (Propensity score matching)

Key Points

To evaluate the efficacy of revascularization and immediate outcomes in off-pump versus on-pump CABG using microsurgical techniques.
Retrospective study of 534 patients who underwent CABG
Two groups: off-pump (100 patients) and on-pump (434 patients)
Propensity score matching applied for analysis
Primary endpoint: graft patency; secondary endpoints: mortality, complications, and surrogate markers.
Revascularization efficacy similar in both groups before (85% vs. 83.2%) and after matching (86.5% vs. 84.3%)
No significant difference in mortality or major complications between groups
Off-pump group had lower acute kidney injury incidents and atrial fibrillation rates
Off-pump surgery resulted in shorter ventilation time, lower CK-MB levels, and shorter hospital stays after matching.

Abstract

Objective. To analyze the efficacy of revascularization and immediate outcomes of on-pump and off-pump coronary artery bypass grafting (CABG) using microsurgical techniques and microscope. Material and methods. A single-center retrospective study included 534 patients who underwent CABG using microsurgical techniques and microscope between 2014 and 2024: group 1 (off-pump, n=100) and group 2 (control, on-pump, n=434). Propensity score matching (PSM) was applied to balance both groups for 19 parameters (89 pairs). The primary endpoint was efficacy of revascularization (patency of all grafts). Secondary endpoints included in-hospital and 30-day mortality, myocardial infarction, stroke, repeat revascularization; specific complications (acute kidney injury, atrial fibrillation, etc.); and surrogate markers. Results. Revascularization efficacy was comparable between groups before (85% vs. 83.2%, p=0.765) and after PSM (86.5% vs. 84.3%, p=0.832). Omission of cardiopulmonary bypass did not affect this outcome (OR after PSM: 1.20; 95% CI 0.52—2.76, p=0.671). There were no significant differences in rates of in-hospital/30-day mortality, myocardial infarction, stroke, or repeat revascularization. Before PSM, the off-pump group demonstrated significant advantages: lower incidence of acute kidney injury (AKI) (p=0.001) and atrial fibrillation (AF) (p=0.036), shorter ventilation time (p=0.008), less need for red blood cell transfusion (p=0.013), higher hematocrit (p=0.005) and glomerular filtration rate (GFR) (p<0.001), lower creatine kinase-MB (CK-MB) (p<0.001) and shorter hospital stay (p<0.001). After PSM (89 pairs), the advantages of the off-pump group persisted for key indicators: shorter ventilation (p=0.011), lower CK-MB (p<0.001), higher GFR (p=0.010), as well as a lower incidence of AKI (p=0.031) and AF (p=0.047). Conclusion. In CABG with microsurgical technique and microscope, omission of cardiopulmonary bypass does not compromise revascularization efficacy. Moreover, it is associated with more favorable early postoperative course.

Effectiveness of revascularization and immediate outcomes after off-pump coronary artery bypass surgery using microvascular techniques and surgical microscope. (Propensity score matching)

Key Points

Abstract

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