Clinical and Angiographic Outcome of Coronary Surgery with and without Cardiopulmonary Bypass: A Prospective Randomized Trial
DOI:
https://doi.org/10.1532/hsf.1015Abstract
Background: Off-pump coronary artery bypass surgery has emerged as an alternative technique to traditional on-pump surgery. The aim of this randomized study was to compare perioperative morbidity and mortality and intraoperative and short-term graft patency in off-pump and on-pump coronary artery bypass grafting.
Methods: One hundred twenty patients were randomized for coronary revascularization with or without cardiopulmonary bypass. In all patients grafts and anastomoses were monitored with transit time Doppler ultrasonography and angiography. Angiography was repeated 3 months after the procedure in 115 of the patients.
Results: Angiography 3 months postoperatively revealed that internal mammary artery patency was 98% in both groups. Vein graft patency was 83% in the off-pump group and 91% in the on-pump group, a difference that was not statistically significant. One perioperative death was recorded in each group. Two strokes were recorded in the on-pump group, none in the off-pump group.
Conclusion: In this prospective, controlled study, perioperative and short-term outcome of off-pump coronary surgery equaled that of on-pump surgery.
References
Nathoe HM, van Dijk D, Janssen EWL, et al. 2003. A comparison of on-pump and off-pump coronary bypass surgery in low risk patients. N Engl J Med 348:394-402.nPlomondon ME, Cleveland JC, Ludwig ST, et al. 2001. Off-pump coronary artery bypass is associated with improved risk adjusted outcomes. Ann Thorac Surg 72:114-9.nPuskas JD, Thourani VH, Marshall JJ, et al. 2001. Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients. Ann Thorac Surg 71:1477-84.nPuskas JD, Williams WH, Duke PG, et al. 2003. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements and length of stay: a prospective randomized comparison of 200 unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg 125:797-808.nRoach GW, Kanchuger M, Mangano CM, et al. 1996. Adverse cerebral outcomes after coronary bypass surgery. N Engl J Med 335:1857-63.nSabik JF, Gillinov AM, Blackstone EH, et al. 2002. Does off-pump coronary surgery reduce morbidity and mortality? J Thorac Cardiovasc Surg 124:698-707.nVan Dijk D, Nierich AP, Jansen EWL, et al. 2001. Early outcome after off-pump versus on-pump coronary surgery: results from a randomized study. Circulation 104:1761-6.nAngelini GD, Taylor FC, Reeves BC, et al. 2002. Early and midterm outcome after off-pump and on-pump surgery in beating heart against cardioplegic arrest studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet 359:1194-9.nAscione R, Williams S, Lloyd CT, et al. 2001. Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: a prospective randomized study. J Thorac Cardiovasc Surg 121:689-96.nBoyd WD, Desai ND, Del Rizzo DF, et al. 1999. Off-pump surgery decreases postoperative complications and resource utilization in the elderly. Ann Thorac Surg 68:1490-3.nCleveland JC, Shroyer LW, Chen AY, et al. 2001. Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 72:1282-9.nD'Ancona G, Karamanoukian HL, Ricci M, et al. 2000. Graft revision after transit time flow measurement in off pump coronary artery bypass grafting. Eur J Cardiothorac Surg 17:287-93.nFosse E, Hol PK, Samset E, et al. 2000. Integrating image-guidance into the cardiac operating room. Minim Invasive Ther Allied Technol 9:403-9.nHernandez F, Cohn WE, Baribeau YR, et al. 2001. In hospital outcomes of off-pump versus on-pump coronary artery bypass procedures: a multi-center experience. Ann Thorac Surg 72:1528-34.nHol PK, Fosse E, Lundblad R, et al. 2002. The importance of intraoperative angiographic findings for predicting long term patency in coronary artery bypass operations. Ann Thorac Surg 73:813-8.nHol PK, Fosse E, Mørk BE, et al. 2001. Graft control by transit time flow measurement and intraoperative angiography in coronary artery bypass surgery. Heart Surg Forum 4:254-8.nLund C, Hol PK, Lundblad R, et al. 2003. A comparison of cerebral embolization during off-pump and on-pump coronary artery bypass surgery. Ann Thorac Surg 76:765-70.nMack M, Duhaylongsod FG. 2002. Through the open door! Where has the ride taken us? J Thorac Cardiovasc Surg 124:655-9.nZehr KJ, Handa N, Bonilla LF, et al. 2000. Pitfalls and results of immediate angiography after off-pump coronary artery bypass grafting. Heart Surg Forum 3:293-9.n