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(Circulation. 2005;112:I-366 – I-370.)
© 2005 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Risk-Adjusted Short- and Long-Term Outcomes for On-Pump Versus Off-Pump Coronary Artery Bypass Surgery

Matthew L. Williams, MD; Lawrence H. Muhlbaier, PhD; Jacob N. Schroder, MD; Jonathan A. Hata, MD; Eric D. Peterson, MD; Peter K. Smith, MD; Kevin P. Landolfo, MD; Robert H. Messier, MD; R. Duane Davis, MD; Carmelo A. Milano, MD

From the Department of Surgery, Division of Cardiothoracic Surgery (M.L.W, L.H.M, J.N.S., J.A.H., P.K.S., R.H.M., R.D.D., C.A.M.), Department of Biostatistics and Bioinformatics (L.H.M.), and Department of Medicine, Division of Cardiology (E.D.P.), Duke University Medical Center, Durham, NC; the Duke University Clinical Research Institute (L.H.M., E.D.P.), Durham, NC; the Department of Surgery (M.L.W.), Massachusetts General Hospital, Boston, Mass; and the Department of Surgery (K.P.L.), Section of Cardiothoracic Surgery, Medical College of Georgia, Augusta, Ga.

Correspondence to Dr Carmelo A. Milano, Box 3043, Department of Surgery, Duke University Medical Center, Durham, NC 27703. E-mail milan002{at}mc.duke.edu

Background— Surgeons have adopted off-pump coronary artery bypass grafting (OPCAB) in an effort to reduce the morbidity of surgical revascularization. However, long-term outcome of OPCAB compared with conventional coronary artery bypass grafting (CABG) remains poorly defined.

Methods and Results— Using logistic regression analysis and proportional hazards modeling, short-term and long-term outcomes (perioperative mortality and complications, risk-adjusted survival, and survival/freedom from revascularization) were investigated for patients who underwent OPCAB (641 patients) and CABG-cardiopulmonary bypass (5026 patients) from 1998 to 2003 at our institution. For these variables, follow-up was 98% complete. OPCAB patients were less likely to receive transfusion (odds ratio for OPCAB, 0.80; P=0.037), and there were trends toward improvement in other short-term outcomes compared with CABG-cardiopulmonary bypass. Long-term outcomes analysis demonstrated no difference in survival, but OPCAB patients were more likely to require repeat revascularization (OPCAB hazard ratio, 1.29; P=0.020).

Conclusions— OPCAB patients were less likely to receive transfusion during their hospitalization for surgery but had higher risk for revascularization in follow-up. These results highlight the need for a large randomized, controlled trial to compare these 2 techniques.

Key Words: CABG surgery • off-pump surgery • OPCAB • long-term