on November 22, 2004
Published online before print November 22, 2004, doi: 10.1161/01.CIR.0000148139.79580.36
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Submitted on December 29, 2003
From Cardiocenter, 3rd Medical School, Charles University, Hospital Kralovske Vinohrady, Prague, Czech Republic. * To whom correspondence should be addressed. E-mail: widim{at}fnkv.cz.
Background--Off-pump coronary bypass surgery has become a widely used technique during recent years. However, limited data are available with regard to 1-year patency of bypass grafts implanted on the beating heart in unselected consecutive bypass surgery candidates. The aim of this study was to compare 1-year angiographic patency of bypass grafts done on the beating heart (off pump) with those done classically (on pump). Methods and Results--The PRAGUE-4 trial randomized 400 consecutive nonselected cardiac surgery candidates into group A (on pump; n=192) and group B (off pump; n=208). One-year follow-up coronary angiography was done in 255 patients. The arterial graft patency after 1 year was 91% in both groups. Saphenous graft patency was 59% (on pump) versus 49% (off pump; P=NS). Saphenous graft patency per patient was lower in the off-pump group: 0.7 patent anastomosis per patient versus 1.1 patent anastomosis in the on-pump group (P<0.01). There were 46% on-pump patients with all grafts patent versus 52% off-pump patients (P=NS). Grafts anastomosed distally to collateralized chronic total occlusions of native coronary arteries remained patent in 100% on the left anterior descending artery compared with 23% on other arteries (P<0.0001). Conclusions--The patency of arterial coronary bypass grafts done on the beating heart is excellent and equal to grafts done on pump. The off-pump procedure in the unselected patient population results in fewer patent saphenous grafts per patient.
Revised on June 21, 2004
Accepted on July 21, 2004
One-Year Coronary Bypass Graft Patency. A Randomized Comparison Between Off-Pump and On-Pump Surgery Angiographic Results of the PRAGUE-4 Trial
Petr Widimsky MD, DrSc, FESC*,
Key words: angiography • coronary artery bypass • heart • surgery
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Circulation 2004 110: 3399.
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