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(Circulation. 2007;116:1145-1152.)
© 2007 American Heart Association, Inc.

Health Services and Outcomes Research

Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery

Differences in Short-Term Outcomes and in Long-Term Mortality and Need for Subsequent Revascularization

Edward L. Hannan, PhD; Chuntao Wu, MD, PhD; Craig R. Smith, MD; Robert S.D. Higgins, MD; Russell E. Carlson, MD; Alfred T. Culliford, MD; Jeffrey P. Gold, MD; Robert H. Jones, MD

From University at Albany, State University of New York (E.L.H., C.W.), Albany, NY; Columbia-Presbyterian Medical Center (C.R.S.), New York, NY; Rush University Medical Center (R.S.D.H.), Chicago, Ill; Mercy Hospital (R.E.C.), Buffalo, NY; New York University Medical Center (A.T.C.), New York, NY; Medical University of Ohio (J.P.G.), Toledo, Ohio; and Duke University Medical Center (R.H.J.), Durham, NC.

Correspondence to Edward L. Hannan, PhD, State University of New York at Albany, Department of Health Policy, Management, and Behavior, One University Place, Rensselaer, NY 12144. E-mail elh03{at}health.state.ny.us

Received December 12, 2006; accepted June 15, 2007.

Background— Off-pump coronary artery bypass graft surgery (OPCAB) has been performed for many years, but its use is increasing in frequency, and it remains an open question whether OPCAB is associated with better outcomes than on-pump coronary artery bypass graft (CABG) surgery.

Methods and Results— New York State patients who underwent either OPCAB with median sternotomy (13 889 patients) or on-pump CABG surgery (35 941 patients) between 2001 and 2004 were followed up via New York databases. Short- and long-term outcomes were compared after adjustment for patient risk factors and after patients were matched on the basis of significant predictors of type of CABG surgery. OPCAB had a significantly lower inpatient/30-day mortality rate (adjusted OR 0.81, 95% confidence interval [CI] 0.68 to 0.97), lower rates for 2 perioperative complications (stroke: adjusted OR 0.70, 95% CI 0.57 to 0.86; respiratory failure: adjusted OR 0.80, 95% CI 0.68 to 0.93), and a higher rate of unplanned operation in the same admission (adjusted OR 1.47, 95% CI 1.01 to 2.15). In the matched samples, no difference existed in 3-year mortality (hazard ratio 1.08, 95% CI 0.96 to 1.22), but OPCAB patients had higher rates of subsequent revascularization (hazard ratio 1.55, 95% CI 1.33 to 1.80). The 3-year OPCAB and on-pump survival rates for matched patients were 89.4% and 90.1%, respectively (P=0.20). For freedom from subsequent revascularization, the respective rates were 89.9% and 93.6% (P<0.0001).

Conclusions— OPCAB is associated with lower in-hospital mortality and complication rates than on-pump CABG, but long-term outcomes are comparable, except for freedom from revascularization, which favors on-pump CABG.

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