title: Off-Pump coronary artery bypass surgery is associated with worse arterial and saphenous vein graft patency and less effective revascularization: Results from the Veterans Affairs Randomized On/Off Bypass (ROOBY) trial.
abstract: BACKGROUND
  The Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) trial compared clinical and angiographic outcomes in off-pump versus on-pump coronary artery bypass graft (CABG) surgery to ascertain the relative efficacy of the 2 techniques.
  
  
  RESULTS
  From February 2002 to May 2007, the ROOBY trial randomized 2203 patients to off-pump versus on-pump CABG. Follow-up angiography was obtained in 685 off-pump (62%) and 685 on-pump (62%) patients. Angiograms were analyzed (blinded to treatment) for FitzGibbon classification (A=widely patent, B=flow limited, O=occluded) and effective revascularization. Effective revascularization was defined as follows: All 3 major coronary territories with significant disease were revascularized by a FitzGibbon A-quality graft to the major diseased artery, and there were no new postanastomotic lesions. Off-pump CABG resulted in lower FitzGibbon A patency rates than on-pump CABG for arterial conduits (85.8% versus 91.4%; P=0.003) and saphenous vein grafts (72.7% versus 80.4%; P<0.001). Fewer off-pump patients were effectively revascularized (50.1% versus 63.9% on-pump; P<0.001). Within each major coronary territory, effective revascularization was worse off pump than on pump (all P≤0.001). The 1-year adverse cardiac event rate was 16.4% in patients with ineffective revascularization versus 5.9% in patients with effective revascularization (P<0.001).
  
  
  CONCLUSIONS
  Off-pump CABG resulted in significantly lower FitzGibbon A patency for arterial and saphenous vein graft conduits and less effective revascularization than on-pump CABG. At 1 year, patients with less effective revascularization had higher adverse event rates.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00032630.
authors.affiliation: Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO 80220, USA. brack.hattler@va.gov
authors.forename: Brack
authors.initials: B
authors.lastname: Hattler
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.forename: A Laurie
authors.initials: AL
authors.lastname: Shroyer
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Collins
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Haugen
authors.forename: Joel A
authors.initials: JA
authors.lastname: Garcia
authors.forename: Janet H
authors.initials: JH
authors.lastname: Baltz
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cleveland
authors.forename: Dimitri
authors.initials: D
authors.lastname: Novitzky
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D017534:Radial Artery / Q000502:physiology / Q000637:transplantation; D012501:Saphenous Vein / Q000502:physiology / Q000637:transplantation; D014654:Vascular Patency / Q000502:physiology; D014728:Veterans