title: Off-pump versus on-pump coronary artery bypass surgery in patients with triple-vessel disease and enlarged ventricles.
abstract: OBJECTIVE
  Off-pump coronary artery bypass grafting (OPCAB) is a popular treatment for patients with ischemic heart disease, especially for high-risk patients. However, whether OPCAB can lead to better clinical outcomes than on-pump coronary artery bypass grafting (ONCAB) in patients with enlarged ventricles remains controversial. This prospective randomized study was designed to characterize comparison of early clinical outcome and mid-term follow-up following ONCAB versus OPCAB in patients with triple-vessel disease and enlarged ventricles.
  
  
  METHODS
  Prospective randomized trial of patients treated at The First Affiliated Hospital, China Medical University, over a 3-year period (2007-2010).
  
  
  METHODS
  A total of 102 patients with triple-vessel disease and enlarged ventricles (end-diastolic dimension >=6.0 cm) were randomized to OPCAB or ONCAB between July 2007 and December 2010. The in-hospital out.comes were analyzed. The study included a mid-term follow-up, with a mean follow-up time of 49.40 (12.88 months).
  
  
  RESULTS
  No significant differences were recorded in the baseline clinical characteristics of ONCAB and OPCAB groups. A statistical difference was found between the two groups at the time of extubation, intensive care unit stay, hospital stay, blood requirements, incidence of intra-aortic balloon pump support, pulmonary complications, stroke, reoperation for bleeding, and inotropic requirements > 24 hours (P < .05). The number of anastomoses performed per patient, the incidence of postoperative ventricular arrhythmia, myocardial infarction, new-onset atrial fibrillation, hemodialysis, infective complications, recurrent angina, and percutaneous reintervention were similar between the 2 groups (P > .05). The left ventricular end-diastolic dimension was significantly smaller at 6 months' follow-up in the 2 groups than it was before operation ( < .05). No differences in hospital mortality and mid-term mortality between OPCAB and ONCAB groups were found. During the follow-up, no patient in either group had undergone repeat coronary artery bypass grafting.
  
  
  CONCLUSIONS
  No differences in early and mid-term mortality were found between OPCAB and ONCAB in patients with triple-vessel disease and enlarged ventricles. However, OPCAB seems to have a beneficial effect on postoperative complications.
authors.forename: Lei
authors.initials: L
authors.lastname: Yu
authors.affiliation: Tianxiang Gu, MD, PhD, Dept. of Cardiac Surgery,, he First Affiliated Hospital,, China Medical University,, Nanjingbei street 155#,, Shenyang, China, 110001, T: 86-24-83283455, F: 86-24-83283455, cmugtx@sina.com.
authors.forename: Tianxiang
authors.initials: T
authors.lastname: Gu
authors.forename: Enyi
authors.initials: E
authors.lastname: Shi
authors.forename: Chun
authors.initials: C
authors.lastname: Wang
authors.forename: Qin
authors.initials: Q
authors.lastname: Fang
authors.forename: Yang
authors.initials: Y
authors.lastname: Yu
authors.forename: Xiaoqi
authors.initials: X
authors.lastname: Zhao
authors.forename: Cheng
authors.initials: C
authors.lastname: Qian
mesh_terms: D000368:Aged; D002681:China; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome