Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery Outcomes During 6 Years: A Prospective Cohort Study
AbstractGiven the ongoing controversy over the risks and benefits of on-pump versus off-pump coronary artery bypass graft surgery (CABG), we aimed to compare time trends in off- and on-pump CABG long-term outcomes. In this prospective cohort study, the patients who underwent primary isolated non-emergent CABG in Imam Reza Hospital in Mashhad, Iran, in 2006 were followed for 6 years. The patients were contacted to obtain long-term follow-up data such as death, rehospitalization, myocardial infarction, and normal physical activity. The obtained data were analyzed in SPSS software (V: 16) using t-test, Fisher's Exact, chi-square, and Mann-Whitney tests, and relative risk. The significant level was set at P<0.05.The study included 61 patients of whom n=40 (65.6%) underwent off-pump CABG. The mean age of the patients was 59.0±11.31 years, and n=43 (70.5%) were men. No significant differences were found between the two groups in terms of outcomes during the 6 years (e.g., death, rehospitalization, myocardial infarction, and normal physical activity). There was 1 (5.0%) death, overall. Risk-adjusted death did not differ significantly between the off-pump and on-pump groups during the 6 years (RR, 0.952; 95% CI 0.866 to 1.048).According to the results, the outcomes were similar between off-pump and on-pump CABG in patients who underwent primary isolated non-emergent CABG during the 6-year follow-up phase.
Bishawi M, Shroyer AL, Rumsfeld JS, Spertus JA, Baltz JH, Collins JF, et al. Changes in health-related quality of life in off-pump versus on-pump cardiac surgery: Veterans Affairs Randomized On/Off Bypass trial. Ann Thorac Surg 2013;95:1946-51.
Bakaeen FG, Chu D, Kelly RF, Ward HB, Jessen ME, Chen GJ, et al. Performing coronary artery bypass grafting off-pump may compromise long-term survival in a veteran population. Ann Thorac Surg 2013;95:1952-60.
Dalén M, Ivert T, Holzmann MJ, Sartipy U. Long-term survival after off-pump coronary artery bypass surgery: a Swedish nationwide cohort study. Ann Thorac Surg 2013;96:2054-60.
Bakaeen FG, Chu D, Kelly RF, Holman WL, Jessen ME, Ward HB. Perioperative outcomes after on-and off-pump coronary artery bypass grafting. Tex Heart Inst J 2014;41:144-51.
Brewer R, Theurer PF, Cogan CM, Bell GF, Prager RL,Paone G. Morbidity but not mortality is decreased after off-pump coronary artery bypass surgery. Ann Thorac Surg 2014;97:831-6.
Chaudhry UA, Harling L, Rao C, Ashrafian H, Ibrahim M, Kokotsakis J, et al. Off-pump versus on-pump coronary revascularization: metaanalysis of mid-and long-term outcomes. Ann Thorac Surg 2014;98:563-72.
Chu D, Bakaeen FG, Dao TK, LeMaire SA, Coselli JS, Huh J. Onpump versus off-pump coronary artery bypass grafting in a cohort of 63,000 patients. Ann Thorac Surg 2009;87:1820-7.
Wu C, Camacho FT, Culliford AT, Gold JP, Wechsler AS, Higgins RS, et al. A comparison of long-term mortality for off-pump and on-pump coronary artery bypass graft surgery. Circ Cardiovasc Qual Outcomes 2012;5:76-84.
Dhurandhar V, Saxena A, Parikh R, Vallely MP, Wilson MK, Butcher JK, et al. Outcomes of on-pump versus off-pump coronary artery bypass graft surgery in the high risk (AusSCORE> 5). Heart Lung Circ 2015;24:1216-24.
Afilalo J, Rasti M, Ohayon SM, Shimony A, Eisenberg MJ. Off-pump vs. on-pump coronary artery bypass surgery: an updated metaanalysis and meta-regression of
randomized trials. Eur Heart J 2012;33:1257-67.
Hattler B, Messenger JC, Shroyer AL, Collins JF, Haugen SJ, Garcia JA, et al. Off-Pump coronary artery bypass surgery is associated with worse arterial and saphenous vein graft patency and less effective revascularization: Results from the Veterans Affairs Randomized On/Off Bypass (ROOBY) trial. Circulation 2012;125:2827-35
Synnergren MJ, Ekroth R, Odén A, Rexius H, Wiklund L. Incomplete revascularization reduces survival benefit of coronary artery bypass grafting: role of off-pump surgery. J Thorac Cardiovasc Surg 2008;136:29-36.
Grau JB, Johnson CK, Kuschner CE, Ferrari G, Shaw RE, Brizzio ME, et al. Impact of pump status and conduit choice in coronary artery bypass: A 15-year follow-up study in 1412 propensity-matched patients. J Thorac Cardiovasc Surg 2015;149:1027-33.
Takagi H, Umemoto T. Worse long-term survival after off-pump than on-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2014;148:1820-9.
Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et al. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med 2012;366:1489-97.