| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
a Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
b Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
c Rollins School of Public Health, Emory University, Atlanta, Georgia
Accepted for publication December 16, 2010.
* Address correspondence to Dr Puskas, Division of Cardiac Surgery, Emory University Hospital Midtown, 550 Peachtree St, 6th Floor Medical Office Tower, Atlanta, GA 30308 (Email: john.puskas{at}emoryhealthcare.org).
Presented at the Forty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 25–27, 2010.
Background: The Surgical Management of Arterial Revascularization Therapies trial was conceived to rigorously compare completeness of revascularization, clinical outcomes and resource utilization in unselected patients referred for elective, primary coronary artery bypass grafting randomly assigned to undergo off-pump (OPCAB) or conventional on-pump coronary artery bypass grafting using cardiopulmonary bypass (CPB). The goal of this follow-up study was to compare long-term survival, graft patency, myocardial ischemia, and clinical outcomes among survivors who volunteered to return for clinical evaluation and imaging studies.
Methods: Two hundred unselected patients with multivessel coronary artery disease were randomly assigned to OPCAB or CPB coronary artery bypass grafting between March 2000 and August 2001. All-cause mortality was determined by individual patient contact and referencing the Social Security Death Master File. Of 140 survivors, 87 volunteered to return after a minimum of 6.8 years (maximum, 8.4 years; mean, 7.5 years) for assessment of graft patency (computed tomographic angiography) and myocardial ischemia (cardiac positron emission tomography and 12-lead electrocardiogram). Age at follow-up ranged from 38 to 90 years (mean, 68 years).
Results: There were 26 deaths from all causes among OPCAB patients and 31 among CPB patients as of March 30, 2009. Graft patency was similar between groups among 622 grafts assessed by angiography before hospital discharge (99% OPCAB versus 97.7% CPB; p = 0.22, Fisher's exact test), among 511 grafts assessed by angiography at 1 year (93.6% OPCAB versus 95.8% CPB; p = 0.33), and among 190 grafts assessed by computed tomographic angiography at late follow-up (76% OPCAB versus 83.5% CPB; p = 0.44). Twelve of 34 OPCAB (35.3%) and 16 of 39 CPB patients (41.0%) had any ischemia on positron emission tomography scanning (p = 0.62). Four OPCAB patients (11.8%) and 9 CPB patients (23.1%) had an ischemic region in excess of 10% of myocardium (p = 0.21). At late follow-up, recurrent angina had occurred in 11 of 43 (25.6%) OPCAB patients and 5 of 44 (11.4%) CPB patients (p = 0.09). Percutaneous reintervention had been performed at the discretion of blinded local cardiologists in 1 of 43 (2.3%) OPCAB patients and 1 of 44 (2.3%) CPB patients (p = 1.0). No patient in either group has undergone repeat CABG.
Conclusions: In this randomized trial, off-pump and on-pump coronary artery bypass grafting were associated with similar early and late graft patency, incidence of recurrent or residual myocardial ischemia, need for reintervention, and long-term survival.
This article has been cited by other articles:
|
|
 |
|
  M. Pettinari, P. Sergeant, and B. Meuris Quantification of operational learning in off-pump coronary bypass Eur J Cardiothorac Surg, April 1, 2013; 43(4): 709 - 714. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Davierwala, S. Leontyev, M. Misfeld, A. Rastan, D. Holzhey, S. Lehmann, M. A. Borger, and F. W. Mohr No-Touch Aorta Off-Pump Coronary Bypass Operation: Arteriovenous Composite Grafts May Be Used as a Last Resort Ann. Thorac. Surg., March 1, 2013; 95(3): 846 - 852. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Martin and D. Cheng Tranexamic Acid for Routine Use in Off-Pump Coronary Artery Bypass Surgery: Evidence Base "Fait Accompli" or More Research Needed? Anesth. Analg., August 1, 2012; 115(2): 227 - 230. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Hattler, J. C. Messenger, A. L. Shroyer, J. F. Collins, S. J. Haugen, J. A. Garcia, J. H. Baltz, J. C. Cleveland Jr, D. Novitzky, F. L. Grover, et al. 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 Circulation, June 12, 2012; 125(23): 2827 - 2835. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Guerra and J. C. Mota Impact of incomplete surgical revascularization on survival Interact CardioVasc Thorac Surg, February 1, 2012; 14(2): 176 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Urso, J. R. Sadaba, and M. Pettinari Impact of off-pump to on-pump conversion rate on post-operative results in patients undergoing off-pump coronary artery bypass Interact CardioVasc Thorac Surg, February 1, 2012; 14(2): 188 - 193. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Wu, F. T. Camacho, A. T. Culliford, J. P. Gold, A. S. Wechsler, R. S. D. Higgins, S. J. Lahey, C. R. Smith, D. Jordan, and E. L. Hannan A Comparison of Long-Term Mortality for Off-Pump and On-Pump Coronary Artery Bypass Graft Surgery Circ Cardiovasc Qual Outcomes, January 1, 2012; 5(1): 76 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Pepper NICE guidance for off-pump CABG: keep the pump primed Heart, November 1, 2011; 97(21): 1728 - 1730. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
