OBJECTIVE: Off-pump coronary artery bypass grafting reduces postoperative morbidity and uses fewer resources than conventional surgical intervention with cardiopulmonary bypass. However, only 15% to 20% of coronary artery bypass grafting operations use off-pump coronary artery bypass. One reason for not using off-pump coronary artery bypass might be the surgeon's concern about the long-term patency of grafts performed with this technique. Therefore our objective was to compare long-term outcomes in patients randomized to off-pump coronary artery bypass or coronary artery bypass grafting with cardiopulmonary bypass. METHODS: Participants in 2 randomized trials comparing off-pump coronary artery bypass and coronary artery bypass grafting with cardiopulmonary bypass were followed up for 6 to 8 years after surgical intervention to assess graft patency, major adverse cardiac-related events, and health-related quality of life. Patency was assessed by using multidetector computed tomographic coronary angiographic analysis with a 16-slice scanner. Two blinded observers classified proximal, body, and distal segments of each graft as occluded or not. Major adverse cardiac-related events and health-related quality of life were obtained from questionnaires given to participants and family practitioners. RESULTS:Patency was studied in 199 and health-related quality of life was studied in 299 of 349 survivors. There was no evidence of attrition bias. The likelihood of graft occlusion was no different between off-pump coronary artery bypass (10.6%) and coronary artery bypass grafting with cardiopulmonary bypass (11.0%) groups (odds ratio, 1.00; 95% confidence interval, 0.55-1.81; P > .99). Graft occlusion was more likely at the distal than the proximal anastomosis (odds ratio, 1.11; 95% confidence interval, 1.02-1.20). There were also no differences between the off-pump coronary artery bypass and coronary artery bypass grafting with cardiopulmonary bypass groups in the hazard of death (hazard ratio, 1.24; 95% confidence interval, 0.72-2.15) or major adverse cardiac-related events or death (hazard ratio, 0.84; 95% confidence interval, 0.58-1.24), or mean health-related quality of life across a range of domains and instruments. CONCLUSIONS: Long-term health outcomes with off-pump coronary artery bypass are similar to those with coronary artery bypass grafting with cardiopulmonary bypass when both operations are performed by experienced surgeons.
RCT Entities:
OBJECTIVE: Off-pump coronary artery bypass grafting reduces postoperative morbidity and uses fewer resources than conventional surgical intervention with cardiopulmonary bypass. However, only 15% to 20% of coronary artery bypass grafting operations use off-pump coronary artery bypass. One reason for not using off-pump coronary artery bypass might be the surgeon's concern about the long-term patency of grafts performed with this technique. Therefore our objective was to compare long-term outcomes in patients randomized to off-pump coronary artery bypass or coronary artery bypass grafting with cardiopulmonary bypass. METHODS:Participants in 2 randomized trials comparing off-pump coronary artery bypass and coronary artery bypass grafting with cardiopulmonary bypass were followed up for 6 to 8 years after surgical intervention to assess graft patency, major adverse cardiac-related events, and health-related quality of life. Patency was assessed by using multidetector computed tomographic coronary angiographic analysis with a 16-slice scanner. Two blinded observers classified proximal, body, and distal segments of each graft as occluded or not. Major adverse cardiac-related events and health-related quality of life were obtained from questionnaires given to participants and family practitioners. RESULTS: Patency was studied in 199 and health-related quality of life was studied in 299 of 349 survivors. There was no evidence of attrition bias. The likelihood of graft occlusion was no different between off-pump coronary artery bypass (10.6%) and coronary artery bypass grafting with cardiopulmonary bypass (11.0%) groups (odds ratio, 1.00; 95% confidence interval, 0.55-1.81; P > .99). Graft occlusion was more likely at the distal than the proximal anastomosis (odds ratio, 1.11; 95% confidence interval, 1.02-1.20). There were also no differences between the off-pump coronary artery bypass and coronary artery bypass grafting with cardiopulmonary bypass groups in the hazard of death (hazard ratio, 1.24; 95% confidence interval, 0.72-2.15) or major adverse cardiac-related events or death (hazard ratio, 0.84; 95% confidence interval, 0.58-1.24), or mean health-related quality of life across a range of domains and instruments. CONCLUSIONS: Long-term health outcomes with off-pump coronary artery bypass are similar to those with coronary artery bypass grafting with cardiopulmonary bypass when both operations are performed by experienced surgeons.
Authors: Diederik Van Dijk; Erik W L Jansen; Ron Hijman; Arno P Nierich; Jan C Diephuis; Karel G M Moons; Jaap R Lahpor; Cornelius Borst; Annemieke M A Keizer; Hendrik M Nathoe; Diederick E Grobbee; Peter P T De Jaegere; Cor J Kalkman Journal: JAMA Date: 2002-03-20 Impact factor: 56.272
Authors: John D Puskas; Willis H Williams; Elizabeth M Mahoney; Philip R Huber; Peter C Block; Peggy G Duke; James R Staples; Katherine E Glas; J Jeffrey Marshall; Mark E Leimbach; Susan A McCall; Rebecca J Petersen; Dianne E Bailey; William S Weintraub; Robert A Guyton Journal: JAMA Date: 2004-04-21 Impact factor: 56.272
Authors: Hendrik M Nathoe; Diederik van Dijk; Erik W L Jansen; Willem J L Suyker; Jan C Diephuis; Wim-Jan van Boven; Aart Brutel de la Rivière; Cornelius Borst; Cor J Kalkman; Diederick E Grobbee; Erik Buskens; Peter P T de Jaegere Journal: N Engl J Med Date: 2003-01-30 Impact factor: 91.245
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: Paolo Stassano; Luigi Di Tommaso; Mario Monaco; Generoso Mastrogiovanni; Antonino Musumeci; Antonio Contaldo; Paolo Pepino Journal: World J Surg Date: 2010-04 Impact factor: 3.352