One-year coronary bypass graft patency: a randomized comparison between off-pump and on-pump surgery angiographic results of the PRAGUE-4 trial.
BACKGROUND
Off-pump coronary bypass surgery has become a widely used technique during recent years. However, limited data are available with regard to 1-year patency of bypass grafts implanted on the beating heart in unselected consecutive bypass surgery candidates. The aim of this study was to compare 1-year angiographic patency of bypass grafts done on the beating heart (off pump) with those done classically (on pump).


RESULTS
The PRAGUE-4 trial randomized 400 consecutive nonselected cardiac surgery candidates into group A (on pump; n=192) and group B (off pump; n=208). One-year follow-up coronary angiography was done in 255 patients. The arterial graft patency after 1 year was 91% in both groups. Saphenous graft patency was 59% (on pump) versus 49% (off pump; P=NS). Saphenous graft patency per patient was lower in the off-pump group: 0.7 patent anastomosis per patient versus 1.1 patent anastomosis in the on-pump group (P<0.01). There were 46% on-pump patients with all grafts patent versus 52% off-pump patients (P=NS). Grafts anastomosed distally to collateralized chronic total occlusions of native coronary arteries remained patent in 100% on the left anterior descending artery compared with 23% on other arteries (P<0.0001).


CONCLUSIONS
The patency of arterial coronary bypass grafts done on the beating heart is excellent and equal to grafts done on pump. The off-pump procedure in the unselected patient population results in fewer patent saphenous grafts per patient.
Widimsky
Petr
P
Cardiocenter, 3rd Medical School, Charles University, Hospital Kralovske Vinohrady, Srobárova 50, 100 34 Prague 10, Czech Republic. widim@fnkv.cz
Straka
Zbynek
Z
Stros
Petr
P
Jirasek
Karel
K
Dvorak
Jaroslav
J
Votava
Jan
J
Lisa
Libor
L
Budesinsky
Tomas
T
Kolesar
Miroslav
M
Vanek
Tomas
T
Brucek
Petr
P
D000368:Aged; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods / Q000706:statistics & numerical data*; D047549:Coronary Artery Bypass, Off-Pump / Q000706:statistics & numerical data; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003604:Czechoslovakia / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014654:Vascular Patency
D005343:Fibrinolytic Agents