Risk-adjusted short- and long-term outcomes for on-pump versus off-pump coronary artery bypass surgery.
BACKGROUND
Surgeons have adopted off-pump coronary artery bypass grafting (OPCAB) in an effort to reduce the morbidity of surgical revascularization. However, long-term outcome of OPCAB compared with conventional coronary artery bypass grafting (CABG) remains poorly defined.


RESULTS
Using logistic regression analysis and proportional hazards modeling, short-term and long-term outcomes (perioperative mortality and complications, risk-adjusted survival, and survival/freedom from revascularization) were investigated for patients who underwent OPCAB (641 patients) and CABG-cardiopulmonary bypass (5026 patients) from 1998 to 2003 at our institution. For these variables, follow-up was 98% complete. OPCAB patients were less likely to receive transfusion (odds ratio for OPCAB, 0.80; P=0.037), and there were trends toward improvement in other short-term outcomes compared with CABG-cardiopulmonary bypass. Long-term outcomes analysis demonstrated no difference in survival, but OPCAB patients were more likely to require repeat revascularization (OPCAB hazard ratio, 1.29; P=0.020).


CONCLUSIONS
OPCAB patients were less likely to receive transfusion during their hospitalization for surgery but had higher risk for revascularization in follow-up. These results highlight the need for a large randomized, controlled trial to compare these 2 techniques.
Williams
Matthew L
ML
Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27703, USA.
Muhlbaier
Lawrence H
LH
Schroder
Jacob N
JN
Hata
Jonathan A
JA
Peterson
Eric D
ED
Smith
Peter K
PK
Landolfo
Kevin P
KP
Messier
Robert H
RH
Davis
R Duane
RD
Milano
Carmelo A
CA
D000368:Aged; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D047549:Coronary Artery Bypass, Off-Pump / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome