Early graft patency after off-pump and on-pump coronary bypass surgery: a prospective randomized study.
OBJECTIVE
Uncertainty persists regarding the impact of the off-pump technique on coronary bypass graft patency. The primary objective of this study was to assess coronary artery bypass graft patency in patients randomized to off-pump and on-pump multivessel coronary artery bypass grafting (CABG). Secondary objectives were clinical outcomes and neuropsychological functioning.


RESULTS
One hundred and fifty patients were randomized to off-pump (n = 75) or on-pump CABG (n = 75). Graft patency was assessed by multidetector computed tomography 5 weeks after surgery. The two groups were similar regarding patients' characteristics and logistic Euroscore (3.6 vs. 3.7%). Mean number of grafts performed was 3.5 ± 0.6 and 3.5 ± 0.6 in off-pump and on-pump, respectively (P = 0.7). Raw graft patency rate was 89.9% in off-pump and 95.0% in on-pump (OR 2.2, 95% CI 1.07-4.44; P = 0.03). Nineteen (27%) off-pump and 9 (13%) on-pump patients had at least one occluded graft (P = 0.04) and the proportion of patent grafts per patient was 0.91 ± 0.2 in off-pump vs. 0.96 ± 0.1 in on-pump (P = 0.06). However, after adjusting by heparin dose, graft patency was not statistically different between groups (OR 0.87, 95% CI 0.25-2.98, P = 0.83). At 30 days, there was no statistically significant difference in major adverse events and neuropsychological functioning between off-pump and on-pump groups. One-year follow-up showed similar functional class and positive treadmill exercise tests.


CONCLUSIONS
Under the conditions this trial was conducted, CABG performed off-pump had lower overall graft patency rate than on-pump, which was not statistically different after controlling for total heparin dose. Thirty-day complications, neuropsychological functioning, and one-year clinical and functional outcomes were not statistically different between the two techniques.
Sousa Uva
Miguel
M
Department of Cardiac Surgery, Hospital da Cruz Vermelha Portuguesa, Lisbon 1549-008, Portugal. uvamiguel@hotmail.com
Cavaco
Sara
S
Oliveira
António G
AG
Matias
Fernando
F
Silva
Catarina
C
Mesquita
Armindo
A
Aguiar
Pedro
P
Bau
José
J
Pedro
Albino
A
Magalhães
Manuel Pedro
MP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D014654:Vascular Patency
D000925:Anticoagulants; D006493:Heparin