Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study.
BACKGROUND
The use of cardiopulmonary bypass during coronary artery bypass surgery (CABG) has been associated with substantial morbidity. The recent introduction of cardiac stabilizers facilitates CABG without cardiopulmonary bypass (off-pump CABG), but it is unknown whether cardiac outcome after off-pump surgery is similar to that for the on-pump procedure.


RESULTS
In a multicenter trial, 281 patients (mean age 61 years, SD 9 years) were randomly assigned to off-pump or on-pump CABG. In-hospital results and cardiac outcome and quality of life after 1 month are presented. Cardiac outcome was defined as survival free of stroke, myocardial infarction, and coronary reintervention. The mean numbers of distal anastomoses per patient were 2.4 (SD 1.0) and 2.6 (SD 1.1) in the off-pump and on-pump groups, respectively. Completeness of revascularization was similar in both groups. Blood products were needed during 3% of the off-pump procedures and 13% of the on-pump procedures (P<0.01). Release of creatine kinase muscle-brain isoenzyme was 41% less in the off-pump group (P<0.01). Otherwise, no differences in complications were found postoperatively. Off-pump patients were discharged 1 day earlier. At 1 month, operative mortality was zero in both groups, and quality of life had improved similarly. In both groups, 4% of the patients had recurrent angina. The proportions of patients surviving free of cardiovascular events were 93.0% in the off-pump group and 94.2% in the on-pump group (P=0.66).


CONCLUSIONS
In selected patients, off-pump CABG is safe and yields a short-term cardiac outcome comparable to that of on-pump CABG.
van Dijk
D
D
University Medical Center Utrecht, Department of Anesthesiology, the Julius Center for Patient Oriented Research, Utrecht, The Netherlands.
Nierich
A P
AP
Jansen
E W
EW
Nathoe
H M
HM
Suyker
W J
WJ
Diephuis
J C
JC
van Boven
W J
WJ
Borst
C
C
Buskens
E
E
Grobbee
D E
DE
Robles De Medina
E O
EO
de Jaegere
P P
PP
D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D018572:Disease-Free Survival; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007432:Intraoperative Period / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D011184:Postoperative Period; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome