Comparison between off- and on-pump coronary artery bypass grafting: long-term results of a real-world registry.
OBJECTIVE
The aim of this study was to compare 5-year rates of overall death, cardiac-related death, myocardial infarction, repeat revascularization, stroke and new occurrence of postoperative renal failure in a large cohort of patients with coronary disease, treated with on- or off-pump coronary artery bypass grafting (CABG).


METHODS
Two propensity score-matched cohorts, each of 560 patients, undergoing isolated surgical coronary revascularization at the regional public and private centres of Emilia-Romagna region (Italy) over the period 1 January 2003 - 31 December 2013, were used to compare long-term outcomes of on-pump CABG (6711 patients) and off-pump CABG (597 patients).


RESULTS
The matched on-pump group received significantly more bypass grafts than the matched off-pump group (2.4 ± 1.1 vs 1.6 ± 0.9, P < 0.0001). The on-pump group reported statistically significant lower cardiac-related mortality. There was a trend towards higher overall mortality and the need for repeat revascularization procedures in the off-pump group. No difference was found for myocardial infarction, stroke or new occurrence of postoperative renal failure between groups in the follow-up. The multivariate analysis of significant predictors of mortality in the overall population confirmed that the off-pump revascularization strategy was an independent predictor of death at long-term follow-up. On-pump CABG reported significantly better results in terms of mortality in the subgroups of patients with a depressed left ventricular ejection fraction and in patients with three-vessel disease.


CONCLUSIONS
In patients undergoing elective isolated CABG, on-pump strategy conferred a long-term survival advantage compared with off-pump strategy, particularly for patients with more extensive coronary disease. No benefits were found in terms of reduction of postoperative morbidity with the off-pump strategy. On-pump surgery should be the preferred revascularization technique, and off-pump surgery reserved for patients for whom the perioperative risk of cardiopulmonary bypass is greater than the risk of a less complete coronary revascularization.
Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy francesco.nicolini@unipr.it.
Francesco
F
Nicolini
Regional Agency for Health and Social Care, Emilia-Romagna Region, Bologna, Italy.
Daniela
D
Fortuna
Cardiac Surgery Unit, Surgery Department, Parma Hospital, Parma, Italy.
Giovanni Andrea
GA
Contini
Cardio-Thoracic-Vascular Department, University Hospital S.Orsola-Malpighi, Bologna, Italy.
Davide
D
Pacini
Department of Clinical Cardiology and Thoraco Vascular Surgery, Hesperia Hospital, Modena, Italy.
Davide
D
Gabbieri
Department of Cardiology and Cardiac Surgery, Villa Maria Cecilia Hospital, Lugo (Ravenna), Spain.
Claudio
C
Zussa
Regional Agency for Health and Social Care, Emilia-Romagna Region, Bologna, Italy.
Rossana
R
De Palma
Cardiac Surgery Unit, Surgery Department, Parma Hospital, Parma, Italy.
Antonella
A
Vezzani
Cardiac Surgery Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
Tiziano
T
Gherli
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
Cardiac surgery; Coronary artery bypass grafting; Off-pump