Abstract 3722: A Randomized Comparison of Off-Pump and On-Pump Stable Multivessel Coronary Artery Bypass Grafting: Long-term Follow-up
Background: Although excellent clinical results have been reported, the safety of Cardiopul-monary Bypass (CPB) has been questioned. Possible benefits gained by avoidance of cardiopulmonary bypass have led to renewed interest in off-pump surgery, but it is uncertain whether the outcome is similar to that involving the use of CPB (on-pump). We undertook a prospective, randomized, controlled study to compare the outcome after on-pump and off-pump surgery
Methods: In a single-center, randomized trial, 214 patients undergoing myocardial revascularization were randomly assigned: 106 to OPCAB and 108 to ONCAB. Both surgical and anesthetic techniques were standardized. Primary end-points were defined as overall cardiac death, myocardial infarction, and further revascularization. Physiological inflammatory responses; hematological dysfunction; and neurological, renal and pulmonary complications were also analyzed. Quality of life and cost effectiveness were evaluated at the end of follow-up. Event-free survival between the 2 groups was analyzed using Kaplan-Meier methods.
Results: The in-hospital outcomes analyses showed significant differences between the time needed for the 2 surgical strategies (4:54 vs.4:12 hr) (P=0.0001). Furthermore, in the OPCAB group compared with ONCAB, there was a statistical difference in the length of stay in the intensive care unit (43:53 vs.31:33 hr) (P=0.0001), time to extubation (1:58 vs. 2:58 hr) (P=0.001), hospital stay (10.16 vs 7.54 days) (P=0.001), and a higher incidence of atrial fibrillation (6 vs 16) (P=0.001). The number of grafts per patient was higher in the ONCAB group (3.1 vs. 2.1 grafts) than in the OPCAB group (P=0.001) Combined end-points and cerebrovascular accidents, deep sternal wound infections, acute renal failure, were not different between the 2 groups.
Conclusion: In this randomized study, OPCAB surgery was as safe and effective as ONCAB surgery with similar outcomes. Although OPCAB surgery was related to a lower number of grafts and higher episodes of atrial fibrillation, this had no implications for long-term outcomes.