EComment. Does off-pump coronary endarterectomy improve long-term outcomes?

Abstract

The publication by Takahashi et al. highlights an area with limited data [1]. They successfully performed off-pump coronary endarterectomy to the left anterior descending (LAD) artery in 12 patients. We congratulate the authors for their effort and successful results. In this report, there are a few topics we would like to discuss. The study population belonged to a consecutive series of 232 off-pump cases performed by a single surgeon. We believe that the surgeon's preference and experience played major role on the outcomes of coronary artery bypass grafting (CABG), particularly on graft patency. The ROOBY trial, which represents the largest randomized controlled study on off-pump versus on-pump CABG to date, documented that graft patency was significantly and consistently lower in the off-pump group. The results were consistent with 3 major coronary regions, including the LAD. The graft patency rates in the LAD region were 89.0% in the off-pump group and 93.2% in the on-pump group (P = 0.01) on 1-year angiograms. Moreover, the effective revascularization rate was lower in the off-pump group (50.1% vs 63.9%; P = 0.001) [2]. In on-pump coronary endarterectomy cases propensity-matched to CABG alone, Lapar et al. documented comparable operative mortality, major complication and long-term survival rates [3]. Similarly, Schwann et al. reported survival benefits in on-pump CABG patients with endarterectomy similar to that described in isolated CABG patients with the use of multiple arterial grafts [4]. There are no studies documenting this relation between off-pump endarterectomy and isolated CABG. Due to the abovementioned facts, we do not think that patients will really benefit from off-pump endarterectomy. Conflict of interest: none declared