Circulation. 2001;104:1761-1766
doi: 10.1161/hc4001.097036
doi: 10.1161/hc4001.097036
(Circulation. 2001;104:1761.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Early Outcome After Off-Pump Versus On-Pump Coronary Bypass Surgery
Results From a Randomized Study
From the University Medical Center Utrecht, Departments of Anesthesiology (D.v.D., J.C.D.), Cardiothoracic Surgery (E.W.L.J.), and Cardiology (H.M.N., C.B., E.O.R.d.M., P.P.T.d.J.) and the Julius Center for Patient Oriented Research (E.B., D.E.G.), Utrecht; the Isala Clinics, Weezenlanden Hospital, Departments of Thoracic Anesthesiology (A.P.N.), Cardiothoracic Surgery (W.J.L.S.), and Cardiology, Zwolle; and the Antonius Hospital, Departments of Cardiothoracic Surgery and Cardiology (W.J.v.B.), Nieuwegein, Netherlands.
Reprint requests to Peter P.T. de Jaegere, University Medical Center, Department of Cardiology (HpN E01-207), Heidelberglaan 100, 3584 CX Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands. E-mail p.p.t.dejaegere{at}hli.azu.nl
Background— The use of cardiopulmonary bypass during coronary artery bypass surgery (CABG) has been associated with substantial morbidity. The recent introduction of cardiac stabilizers facilitates CABG without cardiopulmonary bypass (off-pump CABG), but it is unknown whether cardiac outcome after off-pump surgery is similar to that for the on-pump procedure.
Methods and Results— In a multicenter trial, 281 patients (mean age 61 years, SD 9 years) were randomly assigned to off-pump or on-pump CABG. In-hospital results and cardiac outcome and quality of life after 1 month are presented. Cardiac outcome was defined as survival free of stroke, myocardial infarction, and coronary reintervention. The mean numbers of distal anastomoses per patient were 2.4 (SD 1.0) and 2.6 (SD 1.1) in the off-pump and on-pump groups, respectively. Completeness of revascularization was similar in both groups. Blood products were needed during 3% of the off-pump procedures and 13% of the on-pump procedures (P<0.01). Release of creatine kinase muscle-brain isoenzyme was 41% less in the off-pump group (P<0.01). Otherwise, no differences in complications were found postoperatively. Off-pump patients were discharged 1 day earlier. At 1 month, operative mortality was zero in both groups, and quality of life had improved similarly. In both groups, 4% of the patients had recurrent angina. The proportions of patients surviving free of cardiovascular events were 93.0% in the off-pump group and 94.2% in the on-pump group (P=0.66).
Conclusions— In selected patients, off-pump CABG is safe and yields a short-term cardiac outcome comparable to that of on-pump CABG.
Key Words: coronary disease • surgery • cardiopulmonary bypass
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G.J. Murphy, C.S. Rogers, W.B. Lansdowne, I. Channon, H. Alwair, A. Cohen, M. Caputo, and G.D. Angelini Safety, efficacy, and cost of intraoperative cell salvage and autotransfusion after off-pump coronary artery bypass surgery: A randomized trial J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 20 - 28. [Abstract] [Full Text] [PDF]
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T. D.L. Keenan, Y. Abu-Omar, and D. P. Taggart Bypassing the Pump: Changing Practices in Coronary Artery Surgery Chest, July 1, 2005; 128(1): 363 - 369. [Abstract] [Full Text] [PDF]
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H. P. Grocott, H. M. Homi, and F. Puskas Cognitive Dysfunction After Cardiac Surgery: Revisiting Etiology Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2005; 9(2): 123 - 129. [Abstract] [PDF]
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J. V. Manchio, J. Gu, L. Romar, J. Brown, J. Gammie, R. N. Pierson III, B. Griffith, and R. S. Poston Disruption of Graft Endothelium Correlates With Early Failure After Off-Pump Coronary Artery Bypass Surgery Ann. Thorac. Surg., June 1, 2005; 79(6): 1991 - 1998. [Abstract] [Full Text] [PDF]
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F. Onorati, M. D. Feo, P. Mastroroberto, A. d. Virgilio, A. Esposito, M. Polistena, A. Renzulli, and M. Cotrufo Unstable angina and non-ST segment elevation: surgical revascularization with different strategies Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 1043 - 1050. [Abstract] [Full Text] [PDF]
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A. J. Rastan, H. B. Bittner, J. F. Gummert, T. Walther, C. V. Schewick, E. Girdauskas, and F. W. Mohr On-pump beating heart versus off-pump coronary artery bypass surgery--evidence of pump-induced myocardial injury Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 1057 - 1064. [Abstract] [Full Text] [PDF]
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B. Lo, R. Fijnheer, A. P. Nierich, P. Bruins, and C. J. Kalkman C-Reactive Protein is a Risk Indicator for Atrial Fibrillation After Myocardial Revascularization Ann. Thorac. Surg., May 1, 2005; 79(5): 1530 - 1535. [Abstract] [Full Text] [PDF]
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R. Poston, J. Gu, J. Manchio, A. Lee, J. Brown, J. Gammie, C. White, and B. P. Griffith Platelet function tests predict bleeding and thrombotic events after off-pump coronary bypass grafting Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 584 - 591. [Abstract] [Full Text] [PDF]
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D. Bainbridge, J. Martin, and D. Cheng Off Pump Coronary Artery Bypass Graft Surgery Versus Conventional Coronary Artery Bypass Graft Surgery: A Systematic Review of the Literature Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 105 - 111. [Abstract] [PDF]
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K. Mandal, E. Torsney, J. Poloniecki, A. J. Camm, Q. Xu, and M. Jahangiri Association of High Intracellular, But Not Serum, Heat Shock Protein 70 With Postoperative Atrial Fibrillation Ann. Thorac. Surg., March 1, 2005; 79(3): 865 - 871. [Abstract] [Full Text] [PDF]
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T. L. Frankel, S. C. Stamou, R. C. Lowery, E. I. Kapetanakis, P. C. Hill, E. Haile, and P. J. Corso Risk factors for hemorrhage-related reexploration and blood transfusion after conventional versus coronary revascularization without cardiopulmonary bypass Eur. J. Cardiothorac. Surg., March 1, 2005; 27(3): 494 - 500. [Abstract] [Full Text] [PDF]
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G. W. Staton, W. H. Williams, E. M. Mahoney, J. Hu, H. Chu, P. G. Duke, and J. D. Puskas Pulmonary Outcomes of Off-Pump vs On-Pump Coronary Artery Bypass Surgery in a Randomized Trial Chest, March 1, 2005; 127(3): 892 - 901. [Abstract] [Full Text] [PDF]
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J.-F. Legare, K. J. Buth, and G. M. Hirsch Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial Eur. J. Cardiothorac. Surg., February 1, 2005; 27(2): 296 - 301. [Abstract] [Full Text] [PDF]
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J. Ramsay, S. Shernan, J. Fitch, P. Finnegan, T. Todaro, T. Filloon, and N. A. Nussmeier Increased creatine kinase MB level predicts postoperative mortality after cardiac surgery independent of new Q waves J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 300 - 306. [Abstract] [Full Text] [PDF]
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O. Lev-Ran, R. Braunstein, R. Sharony, A. Kramer, Y. Paz, R. Mohr, and G. Uretzky No-touch aorta off-pump coronary surgery: The effect on stroke J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 307 - 313. [Abstract] [Full Text] [PDF]
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S. G. Raja, A. A. Behranwala, and J. Dunning Does off-pump coronary artery surgery reduce the incidence of postoperative atrial fibrillation? Interactive CardioVascular and Thoracic Surgery, December 1, 2004; 3(4): 647 - 652. [Abstract] [Full Text] [PDF]
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G. J Murphy, R. Ascione, and G. D Angelini Coronary artery bypass grafting on the beating heart: surgical revascularization for the next decade? Eur. Heart J., December 1, 2004; 25(23): 2077 - 2085. [Abstract] [Full Text] [PDF]
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E. A Black, S. Ghosh, K. Sin, T. Spyt, and R. Pillai Off-Pump Coronary Artery Bypass Surgery Asian Cardiovasc Thorac Ann, December 1, 2004; 12(4): 379 - 386. [Abstract] [Full Text] [PDF]
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P. Widimsky, Z. Straka, P. Stros, K. Jirasek, J. Dvorak, J. Votava, L. Lisa, T. Budesinsky, M. Kolesar, T. Vanek, et al. One-Year Coronary Bypass Graft Patency: A Randomized Comparison Between Off-Pump and On-Pump Surgery Angiographic Results of the PRAGUE-4 Trial Circulation, November 30, 2004; 110(22): 3418 - 3423. [Abstract] [Full Text] [PDF]
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N. C. Patel, N. U. Patel, D. F. Loulmet, J. C. McCabe, and V. A. Subramanian Emergency conversion to cardiopulmonary bypass during attempted off-pump revascularization results in increased morbidity and mortality J. Thorac. Cardiovasc. Surg., November 1, 2004; 128(5): 655 - 661. [Abstract] [Full Text] [PDF]
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K. Mandal, M. Jahangiri, M. Mukhin, J. Poloniecki, A. J. Camm, and Q. Xu Association of Anti-Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation Circulation, October 26, 2004; 110(17): 2588 - 2590. [Abstract] [Full Text] [PDF]
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T. Athanasiou, O. Aziz, O. Mangoush, S. Al-Ruzzeh, S. Nair, V. Malinovski, R. Casula, and B. Glenville Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited Eur. J. Cardiothorac. Surg., October 1, 2004; 26(4): 701 - 710. [Abstract] [Full Text] [PDF]
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O. Tagusari, J. Kobayashi, K. Bando, K. Niwaya, H. Nakajima, T. Nakatani, T. Yagihara, and S. Kitamura Total Arterial Off-Pump Coronary Artery Bypass Grafting for Revascularization of the Total Coronary System: Clinical Outcome and Angiographic Evaluation Ann. Thorac. Surg., October 1, 2004; 78(4): 1304 - 1311. [Abstract] [Full Text] [PDF]
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M. J. Mack, P. Brown, F. Houser, M. Katz, A. Kugelmass, A. Simon, S. Battaglia, L. Tarkington, S. Culler, and E. Becker On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in a Matched Sample of Women: A Comparison of Outcomes Circulation, September 14, 2004; 110(11_suppl_1): II-1 - II-6. [Abstract] [Full Text] [PDF]
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N. D. Desai, M. P. Pelletier, H. R. Mallidi, G. T. Christakis, G. N. Cohen, S. E. Fremes, and B. S. Goldman Why Is Off-Pump Coronary Surgery Uncommon in Canada? Results of a Population-Based Survey of Canadian Heart Surgeons Circulation, September 14, 2004; 110(11_suppl_1): II-7 - II-12. [Abstract] [Full Text] [PDF]
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C. A. Palin, R. Kailasam, and C. W. Hogue Jr Atrial Fibrillation After Cardiac Surgery: Pathophysiology and Treatment Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 175 - 183. [Abstract] [PDF]
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S. C. Stamou, K. A. Jablonski, J. M. Garcia, S. W. Boyce, A. S. Bafi, and P. J. Corso Operative mortality after conventional versus coronary revascularization without cardiopulmonary bypass Eur. J. Cardiothorac. Surg., September 1, 2004; 26(3): 549 - 553. [Abstract] [Full Text] [PDF]
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B. Lo, R. Fijnheer, D. Castigliego, C. Borst, C. J. Kalkman, and A. P. Nierich Activation of Hemostasis After Coronary Artery Bypass Grafting With or Without Cardiopulmonary Bypass Anesth. Analg., September 1, 2004; 99(3): 634 - 640. [Abstract] [Full Text] [PDF]
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R. Ascione, B. C. Reeves, M. Pano, and G. D. Angelini Trainees operating on high-risk patients without cardiopulmonary bypass: a high-risk strategy? Ann. Thorac. Surg., July 1, 2004; 78(1): 26 - 33. [Abstract] [Full Text] [PDF]
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G. J.M.G. van der Heijden, H. M. Nathoe, E. W.L. Jansen, and D. E. Grobbee Meta-analysis on the effect of off-pump coronary bypass surgery Eur. J. Cardiothorac. Surg., July 1, 2004; 26(1): 81 - 84. [Abstract] [Full Text] [PDF]
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V. Casati, P. Della Valle, S. Benussi, A. Franco, C. Gerli, P. Baili, O. Alfieri, and A. D'Angelo Effects of tranexamic acid on postoperative bleeding and related hematochemical variables in coronary surgery: Comparison between on-pump and off-pump techniques J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 83 - 91. [Abstract] [Full Text] [PDF]
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E. Weigang, J. Royl, A. Dencker, J. Schoellhorn, A. van de Loo, and F. Beyersdorf Results after MIDCAB and OPCAB surgeries: problems and consequences of incomplete angiographic follow-up in the mid-term course Interactive CardioVascular and Thoracic Surgery, June 1, 2004; 3(2): 302 - 308. [Abstract] [Full Text] [PDF]
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