Long-Term Survival After Off-Pump Coronary Artery Bypass Grafting.
BACKGROUND
The aim of this study was to compare the long-term survival rates of patients undergoing isolated first-time coronary artery bypass grafting (CABG) by off-pump CABG with the long-term survival rates in patients undergoing CABG using cardioplegic cardiopulmonary bypass techniques.


METHODS
All patients undergoing isolated CABG at a single center (Manchester Heart Centre, Manchester, United Kingdom) between 2000 and 2014 were included. Propensity score matching was performed on the basis of on demographic variables. The in-hospital morbidity and long-term all-cause mortality rates for matched patients were compared.


RESULTS
A total of 8,055 patients were identified, with a median follow-up of 7.0 years. With patients matched for preoperative patient characteristics, there was no significant difference in long-term survival between cardiopulmonary bypass and off-pump CABG (n = 2,082 each; 11.5 years vs 11.3 years; p = 0.178). In the off-pump CABG group, there were significantly fewer in-hospital cerebrovascular complications (0.5% vs 1.1%; p = 0.017), and mean length of stay was shorter (7.6 days vs 8.1 days; p < 0.0001). Arterial conduit use was significantly higher in the off-pump group, with more right mammary artery grafts (16.3% vs 4.3%; p < 0.0001) and sequential grafts (27.1% vs 13.5%; p < 0.0001). The mean number of grafts was higher in the on-pump group (3.28 ± 0.94 vs 3.10 ± 1.10; p < 0.0001).


CONCLUSIONS
Long-term survival after off-pump CABG is not inferior to long-term survival after on-pump CABG despite a lower mean number of grafts. A statistically significant difference in cerebrovascular complications may be related to conduit choice and reduced aortic manipulation.
Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
Bilal H
BH
Kirmani
Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
Andrew
A
Brazier
Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
Sanjeevan
S
Sriskandarajah
Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
Zeyad
Z
Alshawabkeh
Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
Lokesh
L
Gurung
Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
Raed
R
Azzam
Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
Daniel J M
DJ
Keenan
Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
Ragheb
R
Hasan
Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom. Electronic address: haitham.abunasra@cmft.nhs.uk.
Haitham
H
Abunasra
D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology