Off-pump versus on-pump myocardial revascularization in low-risk patients with one or two vessel disease: perioperative results in a multicenter randomized controlled trial.
BACKGROUND
To evaluate hospital mortality and morbidity after myocardial revascularization in a prospective and multicenter study, comparing on-pump versus off-pump in a special subset of patients with lesions in the left descending artery, alone or associated with the right coronary artery.


METHODS
A multicenter prospective randomized study was performed. One hundred and sixty selected low-risk patients were enrolled; 80 patients were operated on-pump (coronary artery bypass grafting [CABG], group I) and 80 patients were operated off-pump (off-pump coronary artery bypass [OPCAB], group II). One hundred and five were male and ages ranged from 39 to 70 years old; mean 58.81 +/- 9.31 and median 59. Preoperative clinical characteristics were similar in both groups; only previous myocardial infarction was higher in the OPCAB group. Patients with severe left ventricular dysfunction (FE </= 35%), renal failure and lesions of the circumflex artery and its branches were excluded, as well as patients with significant comorbidities that were inappropriate for randomization because we selected them for OPCAB procedures.


RESULTS
Hospital mortality was 2.5%, three patients (3.7%) in group I (on-pump) and one patient (1.2%) in group II (off-pump) (ns). The number of grafts per patients in group I was 1.81 +/- 0.6, and 1.77 +/- 0.68 in group II (p = 0.833). There was no difference in the total operation time 205.10 +/- 54.30 minutes in group I and 189.50 +/- 55.44 in group II (ns). Six patients (7.5%) had myocardial infarction in group I and three (3.7%) in group II (ns). Bleeding in the postoperative period was 680.50 +/- 434.1 mL in the on-pump group and 678.6 +/- 357.0 mL in the off-pump group (ns). Three patients (3.7%) presented transient neurologic dysfunction in group I and six patients (7.5%) in group II (ns). Intensive care stay was 2.4 +/- 1.0 days in the CABG and 2.3 +/- 0.98 days in the OPCAB group (ns).


CONCLUSIONS
We did not find any statistical difference in hospital mortality and morbidity using on-pump or off-pump techniques for low-risk patients.
Gerola
Luís Roberto
LR
Division of Cardiovascular Surgery, Department of Surgery, Federal University of São Paulo Brasil, Sao Paolo, Brazil. gerola@uol.com.br
Buffolo
Enio
E
Jasbik
Waldir
W
Botelho
Bruno
B
Bosco
João
J
Brasil
Luís A
LA
Branco
João Nelson R
JN
D000328:Adult; D000368:Aged; D001938:Brazil; D002315:Cardiopulmonary Bypass / Q000401:mortality*; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000401:mortality*; D023921:Coronary Stenosis / Q000401:mortality / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors