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(Circulation. 2005;112:I-338 – I-343.)
© 2005 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Early Outcome of a Randomized Comparison of Off-Pump and On-Pump Multiple Arterial Coronary Revascularization

Junjiro Kobayashi, MD; Tadashi Tashiro, MD; Masami Ochi, MD; Hitoshi Yaku, MD; Go Watanabe, MD; Toshihiko Satoh, MD; Osamu Tagusari, MD; Hiroyuki Nakajima, MD; Soichiro Kitamura, MD, for the Japanese Off-Pump Coronary Revascularization Investigation (JOCRI) Study Group

From the Department of Cardiovascular Surgery (J.K., O.T., H.N., S.K.), National Cardiovascular Center, Osaka; the Department of Cardiovascular Surgery (T.T.), University of Fukuoka School of Medicine, Fukuoka; the Division of Cardiovascular Surgery, Department of Surgery (M.O.), Nippon Medical School, Tokyo; the Department of Cardiovascular Surgery (H.Y.), Kyoto Prefectural University of Medicine, Kyoto; the Department of General and Cardiothoracic Surgery (G.W.), Kanazawa University School of Medicine, Kanazawa; and the Department of Preventive Medicine and Public Health (T.S.), Kitasato University School of Medicine, Tokyo, Japan.

Correspondence to Junjiro Kobayashi, MD, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan. E-mail jkobayas{at}hsp.ncvc.go.jp

Background— Previous randomized comparisons of off-pump and on-pump coronary artery bypass grafting (CABG) have yielded controversial results about the cardiac and neurological events and graft patency. In addition, these randomized studies were composed of CABG with a few arterial grafts. We performed a prospective randomized controlled study to compare off-pump and on-pump CABG with multiple arterial grafts.

Methods and Results— Between July, 2002, and September, 2004, 167 consecutive unselected patients referred for elective primary CABG were randomly assigned to undergo multiple arterial off-pump CABG (n=81) or on-pump CABG (n=86). The clinical outcomes and S-100 protein, neuron-specific enolase, and maximum creatine kinase-MB levels were compared. Early graft patency was examined within 3 weeks after the operation by angiography. The number of grafts performed per patient (3.5±1.0 for off-pump CABG and 3.6±0.9 for on-pump CABG) and the number of arterial grafts performed per patient (3.3±1.0 for off-pump CABG and 3.4±0.9 for on-pump CABG) were similar. Completeness of revascularization (completed grafts/planned grafts) was 98% in both procedures. There were no hospital deaths in either group. The operation time was significantly (P<0.001) shorter in the off-pump group than in the on-pump group (267±60 minutes versus 307±59 minutes). The incidence of perioperative complications was similar. The frequency of no need for transfusion was higher in the off-pump group than in the on-pump group (80% versus 55%, P<0.001). The S-100 protein levels at the admission into the intensive care unit were significantly (P<0.001) lower in the off-pump group than in the on-pump group (0.20±0.11 ng/mL versus 0.34±0.22 ng/mL). The neuron-specific enolase levels at the intensive care unit admission were significantly (P<0.001) lower in the off-pump group than in the on-pump group (10.4±9.0 ng/mL versus 16.9±6.9 ng/mL). Maximum creatine kinase-MB levels were significantly (P=0.046) lower in the off-pump group than in the on-pump group (17.1±16.7 IU/L versus 21.5±10.6 IU/L). The overall early graft patency rate with or without stenosis was the same (98%) in both groups, but the rate without stenosis was slightly worse in the off-pump group (93%) than in the on-pump group (96%) (P=0.093). The stenosis-free patency rate in the right coronary area was significantly (P=0.028) worse in the off-pump CABG group (90%) than in the on-pump group (99%).

Conclusions— Off-pump CABG with multiple arterial grafts was as safe as the conventional on-pump CABG, with similar completeness of revascularization and early graft patency.

Key Words: coronary disease • revascularization • angiography