Abstract 4680: Five-year Follow-up of a Randomized Comparison Between Off-Pump and On-Pump on Stable Multivessel Coronary Artery Bypass Grafting
Background: On-pump Coronary Artery Bypass Surgery (ONCAB) is a routine and safe procedure with low mortality in elective patients. Of-pump (OPCAB) and cardioplegic arrest allow performance of coronary artery anastomosis in a steady, bloodless surgical field. OPCAB is associated with similar short -term cardiac outcome than ONCAB; nevertheless, there are few data available on the effects of Of-pump revascularization on, cardiac events and long-term clinical outcomes.
Methods: In a single center randomized trial, 308 patients undergoing myocardial revascularization were randomly assigned: 155 to OPCAB and 153 to ONCAB. Both surgical and anesthetic techniques were standardized. Primary composite end-points were freedom from overall death, myocardial infarction further revascularization (surgery or angioplasty) and cerebrovascular accident. Event- free survival between two groups was analyzed by Kaplan-Meier methods.
Results: At a total of 308 patients, the rates for 5-year event-free survival rates were 88 % for ONCAB, and 90% for OPCAB (p=0.59). Regarding to combined end-points, the adjusted Cox Proportional-Hazard Ratio showed similar effect for ONCAB compared with OPCAB (RR, 0.98; 95%CI 0.66 to 0.84 p=0.94) The in-hospital outcomes analyses showed significant difference between the time of duration for OPCAB and ONCAB strategies respectively (4.9±1.5 vs. 6.6±1.1 hours) p<0.001. In the OPCAB group compared with ONCAB there was statistical difference in the length of stay in ICU (29±8.5 vs.48±7.5 hours) p<0.001, time to extubation (6.7±4.2 vs.10.2±3.5 hours) p<0.001, hospital stay (6.7±1.4 vs 9.2±1.3 days) p<0.001, and higher incidence of atrial fibrillation 33 vs. 5 patients (p<0.001), as well as blood requirement; 46 vs. 64 patients (p<0.001). The number of grafts per patients was higher in the ONCAB group (3.65 vs.2.75 grafts) than OPCAB (p<0.001).
Conclusion: In study, there was no difference between groups in primary composite end-point at five-year follow-up. Although OPCAB surgery was related to a lower number of grafts and higher episodes of atrial fibrillation, it had no implications related to long-term outcomes.