Abstract
Recently published evidence has raised concerns about worse late mortality and increasing need for reintervention after off-pump coronary artery bypass grafting. We undertook this study to assess the impact of off-pump coronary artery bypass grafting on survival and freedom from reintervention at 10 years. From January 2002 to December 2002, 307 consecutive patients who had isolated multivessel off-pump coronary artery bypass grafting at our institution were compared to a control group of 397 patients that underwent multivessel on-pump coronary artery bypass grafting during the same period. In addition, univariate and risk-adjusted comparisons between the two groups were performed at 10 years. Kaplan-Meier survival was similar for the two cohorts. After adjusting for clinical covariates, off-pump coronary artery bypass grafting did not emerge as a significant independent predictor of long-term mortality (Hazard Ratio 0.91; 95% Confidence Interval 0.70–1.12), readmission to hospital for cardiac cause (Hazard Ratio 0.96; 95% Confidence Interval 0.78–1.10), or the need for reintervention (Hazard Ratio 0.93; 95% Confidence Interval 0.87–1.05). Off-pump coronary artery bypass grafting compared with on-pump coronary artery bypass grafting does not adversely impact survival or freedom from reintervention at a 10-year follow-up.
Highlights
For decades cardiac surgeons have been used to performing delicate coronary anastomoses on cardiopulmonary bypass (CPB)
The results of our study comparable to those previously reported by Puskas et al [20] and Angelini et al [21] confirm that Off-pump coronary artery bypass (OPCAB) grafting is associated with similar in-hospital and long-term outcomes compared with on-pump grafting
Takagi and associates have recently published a metaanalysis of randomized controlled trials suggesting that OPCAB grafting may increase late (≥1 year) all-cause mortality by a factor of 1.37 over on-pump grafting [14]
Summary
For decades cardiac surgeons have been used to performing delicate coronary anastomoses on cardiopulmonary bypass (CPB). Evidence in the form of randomized controlled trials and observational studies as well as meta-analyses has demonstrated decreased length of hospitalization, myocardial enzyme release, incidence of atrial fibrillation, and blood product utilization with OPCAB grafting [2,3,4,5,6,7]. To all these advantages we can add the benefits of shorter respiratory support, and fewer cases of pulmonary dysfunction and abnormal renal function [8,9,10,11]. Despite increasing recognition of the benefits of OPCAB grafting, concerns persist regarding its impact on long-term mortality and freedom from reintervention [12,13,14,15]
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