Off-Pump Coronary Artery Bypass Surgery is Associated with Worse Arterial and Saphenous Vein Graft Patency and Less Effective Revascularization: Results From the Veterans Affairs Randomized On/Off Bypass (ROOBY) Trial
Background—The Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) trial compared clinical and angiographic outcomes in off-pump versus on-pump coronary artery bypass graft (CABG) surgery to ascertain the relative efficacy of the two techniques.
Methods and Results—From February 2002 to May 2007, the ROOBY trial randomized 2,203 patients to off-pump vs. on-pump CABG. Follow-up angiography was obtained in 685 (62%) off-pump and 685 (62%) on-pump patients. Angiograms were analyzed (blinded to treatment) for FitzGibbon's classification (A = widely patent, B = flow limited, O = occluded) and effective revascularization. Effective revascularization was defined as follows: all of the 3 major coronary territories with significant disease were revascularized by a FitzGibbon's A quality graft to the major diseased artery and there were no new post-anastomotic lesions. Off-pump CABG resulted in lower FitzGibbon A patency rates than on-pump CABG for arterial conduits (85.8% vs. 91.4%, p = 0.003) and SVGs (72.7 vs. 80.4%, p < 0.001). Fewer off-pump patients were effectively revascularized (50.1% vs. 63.9% on-pump, p < 0.001). Within each major coronary territory, effective revascularization was worse off-pump than on-pump (p values all ≤ 0.001). The 1-year adverse cardiac event rate was 16.4% in patients with ineffective revascularization vs. 5.9% in patients with effective revascularization (p <0.001).
Conclusions—Off-pump CABG resulted in significantly lower FitzGibbon A patency for arterial and SVG conduits and less effective revascularization than on-pump CABG. At 1-year, patients with less effective revascularization had higher adverse event rates.
Clinical Trial Registration Information—clinicaltrials.gov; Identifier: NCT00032630.
- Received September 20, 2011.
- Accepted March 27, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited