title: A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients.
abstract: BACKGROUND
  The performance of coronary bypass surgery without cardiopulmonary bypass ("off pump") may reduce perioperative morbidity and costs, but it is uncertain whether the outcome is similar to that involving the use of cardiopulmonary bypass ("on pump").
  
  
  METHODS
  In a multicenter, randomized trial, we randomly assigned 139 patients with predominantly single- or double-vessel coronary disease to on-pump surgery and 142 to off-pump surgery. Cardiac outcome and cost effectiveness were determined one year after surgery. The uncertainty surrounding the cost-effectiveness ratio (cost differences per quality-adjusted year of life gained) was addressed by bootstrapping.
  
  
  RESULTS
  At one year, the rate of freedom from death, stroke, myocardial infarction, and coronary reintervention was 90.6 percent after on-pump surgery and 88.0 percent after off-pump surgery (absolute difference, 2.6 percent; 95 percent confidence interval, - 4.6 to 9.8). Graft patency in a randomized subgroup of patients was 93 percent after on-pump surgery and 91 percent after off-pump surgery (absolute difference, 2.0 percent; 95 percent confidence interval, - 6.5 to 10.4). On-pump surgery was associated with $1,839 in additional direct costs per patient ($14,908 vs. $13,069--a difference of 14.1 percent) and an increase in quality-adjusted years of life of 0.83 as compared with 0.82 (difference, 0.01 year; 95 percent confidence interval, - 0.03 to 0.04). Off-pump surgery was more cost effective than on-pump surgery in 95 percent of bootstrap estimates.
  
  
  CONCLUSIONS
  In low-risk patients, there was no difference in cardiac outcome at one year between those who underwent on-pump bypass surgery and those who underwent off-pump surgery. Off-pump surgery was more cost effective.
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Hendrik M
authors.initials: HM
authors.lastname: Nathoe
authors.forename: Diederik
authors.initials: D
authors.lastname: van Dijk
authors.forename: Erik W L
authors.initials: EW
authors.lastname: Jansen
authors.forename: Willem J L
authors.initials: WJ
authors.lastname: Suyker
authors.forename: Jan C
authors.initials: JC
authors.lastname: Diephuis
authors.forename: Wim-Jan
authors.initials: WJ
authors.lastname: van Boven
authors.forename: Aart Brutel
authors.initials: AB
authors.lastname: de la Rivière
authors.forename: Cornelius
authors.initials: C
authors.lastname: Borst
authors.forename: Cor J
authors.initials: CJ
authors.lastname: Kalkman
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Erik
authors.initials: E
authors.lastname: Buskens
authors.forename: Peter P T
authors.initials: PP
authors.lastname: de Jaegere
mesh_terms: D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D003327:Coronary Disease / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D018572:Disease-Free Survival; D005260:Female; D006355:Heart-Lung Machine; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D011183:Postoperative Complications; D019057:Quality-Adjusted Life Years; D012086:Reoperation / Q000706:statistics & numerical data; D020521:Stroke