title: Coronary revascularization in transition from on-pump to off-pump: the effect of the off-pump coronary artery bypass on medium-term outcome.
abstract: OBJECTIVE
  We previously reported that early patient outcome, chiefly ischaemic injury, was reduced in patients allocated to off pump coronary artery bypass (OPCAB) surgery. This report concerns the medium-term outcome for this cohort of patients.
  
  
  METHODS
  A prospective observational study was carried out in a single cardiothoracic specialty hospital. Forty-four patients scheduled for elective multivessel coronary artery bypass grafting (CABG) surgery using either off pump (OPCAB) (n=21) or on pump (cardiopulmonary bypass, CPB) (n=23) were included in the study. Data on the symptoms, quality of life, need for cardiovascular therapy, and occurrence of cardiovascular events or death among patients at 6- and 12-months after surgery were collected by a patient questionnaire and reviewing the medical charts.
  
  
  RESULTS
  Compared with patients who underwent CPB surgery, OPCAB patients required a smaller increase in cardiovascular medication (5.6% versus 47.1%; P=0.007) at the 6-month follow-up and demonstrated a trend toward improved symptoms (dyspnea at 6 months, 0, range 0-4 versus 1, range 0-4; P=0.03) and quality of life (Duke Activity Status Index at 6 months, 20.8+5.6 versus 19+6.8; P=0.13). No differences in the incidence of cardiologic intervention or mortality were observed between groups.
  
  
  CONCLUSIONS
  The trend toward improved medium-term outcome variables among patients treated with OPCAB may have owed to the reduced cardiac ischemic injury associated with OPCAB compared with CPB.
authors.affiliation: Department of Anaesthesia and Intensive Care, Royal Brompton and Harefield NHS Trust, Harefield Middlesex, London, UK. janos_gal@hotmail.com
authors.forename: J
authors.initials: J
authors.lastname: Gal
authors.forename: A
authors.initials: A
authors.lastname: Grattan
authors.forename: M D
authors.initials: MD
authors.lastname: Kertai
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.forename: A D
authors.initials: AD
authors.lastname: Shaw
authors.forename: D
authors.initials: D
authors.lastname: Royston
authors.forename: B J
authors.initials: BJ
authors.lastname: Riedel
mesh_terms: D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome