A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery.
BACKGROUND
The effect of the use of coronary-artery bypass surgery without cardiopulmonary bypass and cardiac arrest ("off pump") on graft patency remains uncertain. We undertook a prospective, randomized, controlled study to compare graft-patency rates and clinical outcomes in off-pump surgery with conventional, "on-pump" surgery.


METHODS
We randomly assigned 50 patients to undergo on-pump coronary-artery bypass grafting and 54 to undergo off-pump surgery. Surgical and anesthetic techniques were standardized for both groups. Clinical outcomes and troponin T levels were measured. Three months later, the patients underwent coronary angiography, including quantitative analysis.


RESULTS
The mean age of the patients was 63 years, and 87 percent were men. The on-pump group received a mean of 3.4 grafts, and the off-pump group 3.1 (P=0.41). There were no deaths. There was no significant difference in the median postoperative length of stay between the two groups (seven days in each group). The area under the curve of troponin T levels was higher during the first 72 hours in the on-pump group than in the off-pump group (30.96 hr x microg per liter vs. 19.33 hr x microg per liter, P=0.02). At three months, 127 of 130 grafts were patent in the on-pump group (98 percent), as compared with 114 of 130 in the off-pump group (88 percent, P=0.002). The patency rate was higher for all graft territories in the on-pump group than in the off-pump group.


CONCLUSIONS
In this randomized study, off-pump coronary surgery was as safe as on-pump surgery and caused less myocardial damage. However, the graft-patency rate was lower at three months in the off-pump group than in the on-pump group, and this difference has implications with respect to the long-term outcome.
Khan
Natasha E
NE
Royal Brompton and Harefield National Health Service Trust, London. r.mister@rbh.nthames.nhs.uk
De Souza
Anthony
A
Mister
Rebecca
R
Flather
Marcus
M
Clague
Jonathan
J
Davies
Simon
S
Collins
Peter
P
Wang
Duolao
D
Sigwart
Ulrich
U
Pepper
John
J
D000368:Aged; D019540:Area Under Curve; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000473:pathology / Q000601:surgery*; D023921:Coronary Stenosis; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006355:Heart-Lung Machine; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood; D014654:Vascular Patency
D020107:Troponin T