Comparison between off-pump and on-pump coronary artery bypass grafting in patients with severe lesions at the circumflex artery territory: 5-year follow-up of the MASS III trial (original) (raw)
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Background: Surgical treatment modalities of coronary artery diseases (CAD) include on-pump or off-pump coronary artery bypass grafting (CABG). CABG performed on the beating heart can avoid complications that might occur on cardiopulmonary bypass. Our objective was to compare the effectiveness of on-pump versus off-pump CABG in high-risk patients stratified according to the EuroSCORE scoring system. Methods: This randomized clinical study included 80 high-risk patients who underwent CABG and assigned into two groups; each contains 40 patients. Patients with valvular affection, ischemic ventricular septal defect or left ventricle and aortic aneurysms, and/or those exhibiting significant neurological pathology were excluded from the study. Study outcomes were blood loss, length of ICU and hospital stay, inotropic use, re-exploration rate, and operative mortality. Results: The study showed significant higher use of inotropic drugs intra and post-operatively (57.5% vs 40%, p = 0.021), more low cardiac output (12.5% vs 2.5%, p = 0.031), lower blood loss (337±67 vs 498±68 ml, p = 0.01), lower blood transfusion (1.1±0.2 vs 1.2±0.4 unit, p = 0.024), more prolonged ICU stay (4.0±1.6 vs 3.0±0.9 day, p = 0.001) and the higher re-exploration rate (17.5% vs 7.5%, p = 0.035) in the on-pump group. Hospital stay (8.7±2 vs 8.1±1, p = 0.121) and early mortality (7.5% vs 2.5%, p = 0.451) did not differ significantly between the two groups. Conclusion: Management of coronary artery disease is still challenging, and there is still a place for off-pump CABG in CAD in high-risk patients due to its advantages in the early complications while has the same total hospital stay when compared with on-pump CABG.
Coronary artery bypass grafting: an off-pump versus on-pump review
The Journal of extra-corporeal technology, 2002
There has been a proliferation in the number of coronary artery bypass grafts (CABG) being performed without the use of cardiopulmonary bypass (CPB). However, the benefits of off-pump coronary artery grafting (OPCAB) are still being determined. The aim of this retrospective review was to compare the perioperative outcomes of CPB patients with OPCAB patients and to identify the patients most likely to benefit from the off-pump procedure. We reviewed the perioperative data of all isolated CABG patients at two metropolitan hospitals for the period of August 2000 to September 2001. The two groups (OPCAB vs. CPB) were further divided into subgroups identifying patients by their predicted mortality (higher-risk and lower-risk) and the number of distal graft anastomoses received (1, 2, 3, 4, or 5). A p value less than .05 was considered significant. Out of the total of 882 patients, 46.2% were OPCAB cases. Both CPB and OPCAB groups were similar in terms of demographics and predicted risk o...
International journal of health sciences
Aim: To ascertain the non-inferiority of off-pump CABG when compared to on-pump CABG in terms of angiographically assessed graft patency at 3 months. Material & Methods: This Prospective Randomized comparison of Off-pump and On-pump Multivessel coronary artery bypass surgery To Evaluate outcomes and graft patency (PROMOTE patency) trial was conducted in Indira Gandhi Institute of medical Sciences, Patna, Bihar, India over a period of one year. Results: A total of 300 patients were enrolled and were randomly assigned to either off-pump CABG (n = 150 patients) or on pump CABG (n = 150 patients). Of 300 patients, 280 patients at 1 month and 295 patients at 3 months survived and were analyzed for MACCE. The incidence of asymptomatic carotid artery stenosis was 0.66% (1 patient) in off-pump and 0.66% (1 patient) in on-pump group, p = 1.01 in our study. No difference was observed between the groups in terms of index of completeness of revascularization (number of grafts performed divided ...
Circulation, 2010
Background-Coronary artery bypass graft surgery with cardiopulmonary bypass is a safe, routine procedure. Nevertheless, significant morbidity remains, mostly because of the body's response to the nonphysiological nature of cardiopulmonary bypass. Few data are available on the effects of off-pump coronary artery bypass graft surgery (OPCAB) on cardiac events and long-term clinical outcomes. Methods and Results-In a single-center randomized trial, 308 patients undergoing coronary artery bypass graft surgery were randomly assigned: 155 to OPCAB and 153 to on-pump CAB (ONCAB). Primary composite end points were death, myocardial infarction, further revascularization (surgery or angioplasty), or stroke. After 5-year follow-up, the primary composite end point was not different between groups (hazard ratio 0.71, 95% CI 0.41 to 1.22; Pϭ0.21). A statistical difference was found between OPCAB and ONCAB groups in the duration of surgery (240Ϯ65 versus 300Ϯ87.5 minutes; PϽ0.001), in the length of ICU stay (19.5Ϯ17.8 versus 43Ϯ17.0 hours; PϽ0.001), time to extubation (4.6Ϯ6.8 versus 9.3Ϯ5.7 hours; PϽ0.001), hospital stay (6Ϯ2 versus 9Ϯ2 days; PϽ0.001), higher incidence of atrial fibrillation (35 versus 4% of patients; PϽ0.001), and blood requirements (31 versus 61% of patients; PϽ0.001), respectively. The number of grafts per patient was higher in the ONCAB than the OPCAB group (2.97 versus 2.49 grafts/patient; PϽ0.001). Conclusions-No difference was found between groups in the primary composite end point at 5-years follow-up. Although OPCAB surgery was related to a lower number of grafts and higher episodes of atrial fibrillation, it had no significant implications related to long-term outcomes. Clinical Trial Registration-URL: http://www.controlled-trials.com. Unique identifier: ISRCTN66068876. (Circulation. 2010;122[suppl 1]:S48 -S52.)
Safety and efficacy of off-pump coronary artery bypass grafting
The Annals of Thoracic Surgery, 2000
Background. We evaluated the application of the offpump coronary artery bypass (OPCAB) procedure relative to safety and efficiency as measured by operative mortality postoperative complications and longitudinal outcome.
Early Outcomes of On-pump versus Off-Pump Coronary Artery Bypass Grafting
Pakistan Journal of Medical Sciences, 1969
Coronary-artery bypass graft (CABG) surgery reduces mortality in patients with severe coronary artery disease. 1 During the last 30 years, coronary artery bypass grafting (CABG) was performed primarily with the use of cardiopulmonary bypass system ("on pump") using cardioplegic arrest. Historically, on-pump CABG has shown improvements in ischemic symptoms and prolonged survival in selected patients. 2,3 Using this approach, peri-operative mortality is about 2%, and 5-7% are additional complications along with mortality like myocardial infarction, stroke, and renal failure. 4 In the mid-1990s, interest developed in performing Off-Pump CABG without the use of cardiopulmonary bypass, in order to reduce postoperative
The heart surgery forum, 2002
A consecutive series of patients undergoing first-time coronary artery bypass graft (CABG) surgery were analyzed and the impact of off-pump surgery was evaluated. From January 1, 2000 to December 31, 2000, 367 patients underwent isolated first-time CABG surgery. One hundred and twenty underwent off-pump CABG (Group A, 32.7%) and 247 underwent conventional on-pump CABG (Group B, 67.3%). Five patients were converted during operation and were included in Group A. The pre-operative characteristics, intra-operative details, and post-operative course were analyzed in the two groups. All patients were followed up between 11 and 23 months (median 18 months) after operation by telephone interviews or questionnaire survey. Early mortality was 2.1% (group A, 0.83%; group B, 2.83%), with the difference not being statistically significant. The incidence of post-op stroke (group A, 1.66%; group B, 3.66%), renal failure (group A, 2.5%; group B, 5.66%), and gastrointestinal complications (group A, ...
Global Journal of Health Science, 2014
There are two basic ways of performing coronary artery bypass graft surgery (CABG): on pump CABG and off pump CABG. Off pump CABG is relatively a newer procedure to on-pump CABG and does not require the use of the cardiopulmonary bypass machine. On pump CABG is the more traditional method of performing bypass surgery. However its resultant inflammatory effects cause renal dysfunction, gastrointestinal distress and cardiac abnormalities which have forced the surgeons to look for alternatives to the procedure. An extensive literature search revealed that on pump CABG causes better revascularization as compared to off pump CABG while off pump CABG has a much lower post operative morbidity and mortality especially in high risk patients. We suggest that the technique used should depend on the ease of the surgeon doing the operation as both the methods seem almost equally efficient according to the review.