OBJECTIVE: To compare the clinical, angiographic, neurocognitive, and quality of life outcomes of off-pump coronary artery bypass surgery with conventional coronary artery bypass grafting surgery using cardiopulmonary bypass. DESIGN: Randomised controlled clinical trial. SETTING:Tertiary cardiothoracic centre in Middlesex, England. PARTICIPANTS: 168 patients (27 women) requiring primary isolated coronary artery bypass grafting surgery. INTERVENTIONS: Patients were randomised to conventional coronary artery bypass grafting surgery using cardiopulmonary bypass (n = 84) or off-pump coronary artery bypass surgery (n = 84), carried out by one surgeon. Angiographic examination was carried out at three months postoperatively. Neurocognitive tests were carried out at baseline and at six weeks and six months postoperatively. MAIN OUTCOME MEASURES: Clinical outcome, graft patency at three months, neurocognitive function at six weeks and six months, and health related quality of life. RESULTS:Graft patency was evaluated by angiography in 151 (89.9%) patients and was similar between the cardiopulmonary bypass and off-pump groups (risk difference - 1%, 95% confidence interval - 5% to 4%), with the off-pump group considered the treatment group. Patients in the off-pump group required fewer blood transfusions (1.7 units v 1.0 unit, P = 0.02), shorter duration of mechanical ventilation (7.7 hours v 3.9 hours, P = 0.03), and shorter hospital stay (10.8 days v 8.9 days). Scores for neurocognitive function showed a significant difference in three memory subtests at six weeks and two memory subtests at six months in favour of the off-pump group. CONCLUSIONS: Patients who underwent off-pump coronary artery bypass surgery showed similar patency of grafts, better clinical outcome, shorter hospital stay, and better neurocognitive function than patients who underwent conventional coronary artery bypass grafting surgery using cardiopulmonary bypass.
RCT Entities:
OBJECTIVE: To compare the clinical, angiographic, neurocognitive, and quality of life outcomes of off-pump coronary artery bypass surgery with conventional coronary artery bypass grafting surgery using cardiopulmonary bypass. DESIGN: Randomised controlled clinical trial. SETTING: Tertiary cardiothoracic centre in Middlesex, England. PARTICIPANTS: 168 patients (27 women) requiring primary isolated coronary artery bypass grafting surgery. INTERVENTIONS:Patients were randomised to conventional coronary artery bypass grafting surgery using cardiopulmonary bypass (n = 84) or off-pump coronary artery bypass surgery (n = 84), carried out by one surgeon. Angiographic examination was carried out at three months postoperatively. Neurocognitive tests were carried out at baseline and at six weeks and six months postoperatively. MAIN OUTCOME MEASURES: Clinical outcome, graft patency at three months, neurocognitive function at six weeks and six months, and health related quality of life. RESULTS: Graft patency was evaluated by angiography in 151 (89.9%) patients and was similar between the cardiopulmonary bypass and off-pump groups (risk difference - 1%, 95% confidence interval - 5% to 4%), with the off-pump group considered the treatment group. Patients in the off-pump group required fewer blood transfusions (1.7 units v 1.0 unit, P = 0.02), shorter duration of mechanical ventilation (7.7 hours v 3.9 hours, P = 0.03), and shorter hospital stay (10.8 days v 8.9 days). Scores for neurocognitive function showed a significant difference in three memory subtests at six weeks and two memory subtests at six months in favour of the off-pump group. CONCLUSIONS:Patients who underwent off-pump coronary artery bypass surgery showed similar patency of grafts, better clinical outcome, shorter hospital stay, and better neurocognitive function than patients who underwent conventional coronary artery bypass grafting surgery using cardiopulmonary bypass.
Authors: M F Newman; J L Kirchner; B Phillips-Bute; V Gaver; H Grocott; R H Jones; D B Mark; J G Reves; J A Blumenthal Journal: N Engl J Med Date: 2001-02-08 Impact factor: 91.245
Authors: A M Grigore; J Mathew; H P Grocott; J G Reves; J A Blumenthal; W D White; P K Smith; R H Jones; J L Kirchner; D B Mark; M F Newman Journal: Anesthesiology Date: 2001-11 Impact factor: 7.892
Authors: D van Dijk; A P Nierich; E W Jansen; H M Nathoe; W J Suyker; J C Diephuis; W J van Boven; C Borst; E Buskens; D E Grobbee; E O Robles De Medina; P P de Jaegere Journal: Circulation Date: 2001-10-09 Impact factor: 29.690
Authors: Alina M Grigore; Hilary P Grocott; Joseph P Mathew; Barbara Phillips-Bute; Timothy O Stanley; Aimee Butler; Kevin P Landolfo; Joseph G Reves; James A Blumenthal; Mark F Newman Journal: Anesth Analg Date: 2002-01 Impact factor: 5.108
Authors: Natasha E Khan; Anthony De Souza; Rebecca Mister; Marcus Flather; Jonathan Clague; Simon Davies; Peter Collins; Duolao Wang; Ulrich Sigwart; John Pepper Journal: N Engl J Med Date: 2004-01-01 Impact factor: 91.245
Authors: Victor F Seabra; Sami Alobaidi; Ethan M Balk; Alan H Poon; Bertrand L Jaber Journal: Clin J Am Soc Nephrol Date: 2010-07-29 Impact factor: 8.237