Early outcome of a randomized comparison of off-pump and on-pump multiple arterial coronary revascularization.
BACKGROUND
Previous randomized comparisons of off-pump and on-pump coronary artery bypass grafting (CABG) have yielded controversial results about the cardiac and neurological events and graft patency. In addition, these randomized studies were composed of CABG with a few arterial grafts. We performed a prospective randomized controlled study to compare off-pump and on-pump CABG with multiple arterial grafts.


RESULTS
Between July, 2002, and September, 2004, 167 consecutive unselected patients referred for elective primary CABG were randomly assigned to undergo multiple arterial off-pump CABG (n=81) or on-pump CABG (n=86). The clinical outcomes and S-100 protein, neuron-specific enolase, and maximum creatine kinase-MB levels were compared. Early graft patency was examined within 3 weeks after the operation by angiography. The number of grafts performed per patient (3.5+/-1.0 for off-pump CABG and 3.6+/-0.9 for on-pump CABG) and the number of arterial grafts performed per patient (3.3+/-1.0 for off-pump CABG and 3.4+/-0.9 for on-pump CABG) were similar. Completeness of revascularization (completed grafts/planned grafts) was 98% in both procedures. There were no hospital deaths in either group. The operation time was significantly (P<0.001) shorter in the off-pump group than in the on-pump group (267+/-60 minutes versus 307+/-59 minutes). The incidence of perioperative complications was similar. The frequency of no need for transfusion was higher in the off-pump group than in the on-pump group (80% versus 55%, P<0.001). The S-100 protein levels at the admission into the intensive care unit were significantly (P<0.001) lower in the off-pump group than in the on-pump group (0.20+/-0.11 ng/mL versus 0.34+/-0.22 ng/mL). The neuron-specific enolase levels at the intensive care unit admission were significantly (P<0.001) lower in the off-pump group than in the on-pump group (10.4+/-9.0 ng/mL versus 16.9+/-6.9 ng/mL). Maximum creatine kinase-MB levels were significantly (P=0.046) lower in the off-pump group than in the on-pump group (17.1+/-16.7 IU/L versus 21.5+/-10.6 IU/L). The overall early graft patency rate with or without stenosis was the same (98%) in both groups, but the rate without stenosis was slightly worse in the off-pump group (93%) than in the on-pump group (96%) (P=0.093). The stenosis-free patency rate in the right coronary area was significantly (P=0.028) worse in the off-pump CABG group (90%) than in the on-pump group (99%).


CONCLUSIONS
Off-pump CABG with multiple arterial grafts was as safe as the conventional on-pump CABG, with similar completeness of revascularization and early graft patency.
Kobayashi
Junjiro
J
Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka 565-8565, Japan. jkobayas@hsp.ncvc.go.jp
Tashiro
Tadashi
T
Ochi
Masami
M
Yaku
Hitoshi
H
Watanabe
Go
G
Satoh
Toshihiko
T
Tagusari
Osamu
O
Nakajima
Hiroyuki
H
Kitamura
Soichiro
S
D000368:Aged; D001158:Arteries / Q000637:transplantation; D015415:Biomarkers; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003072:Cognition Disorders / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000097:blood; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D009418:S100 Proteins / Q000097:blood; D016896:Treatment Outcome; D014654:Vascular Patency
D015415:Biomarkers; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase