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. 2020 Mar;36(2):93-104.
doi: 10.1007/s12055-019-00869-0. Epub 2019 Oct 28.

Graft patency at 3 months after off- and on-pump coronary bypass surgery: a randomized trial

Lokeswara Rao Sajja  1   2 , Kunal Sarkar  3 , Gopichand Mannam  1 , Venkata Krishna Kumar Kodali  4 , Chandrasekar Padmanabhan  5 , Sanjeeth Peter  6 , Anvay Mulay  7 , Prashanthi Beri  8
Affiliations

Graft patency at 3 months after off- and on-pump coronary bypass surgery: a randomized trial

Lokeswara Rao Sajja et al. Indian J Thorac Cardiovasc Surg. 2020 Mar.

Abstract

Purpose: Coronary artery bypass grafting (CABG) is performed either with the aid of cardiopulmonary bypass (on-pump) or without cardiopulmonary bypass (off-pump). There is a scarcity of angiographic data to support the non-inferiority of off-pump technique to on-pump technique. The objective of this study is to ascertain the non-inferiority of off-pump CABG when compared to on-pump CABG in terms of angiographically assessed graft patency at 3 months.

Methods: A total of 320 patients with multivessel coronary artery disease were enrolled in a multicenter prospective randomized trial either to on-pump CABG (n = 162) or off-pump CABG (n = 158) between March 2016 through March 2017. Graft patency was evaluated by using either multidetector computerized tomographic angiography or conventional coronary angiography at 3 months. The major adverse cardiac and cardiovascular events (MACCE) were also analyzed at 3 months.

Results: The median number of grafts per patient in off-pump was 3.00 (Q1:3.00 and Q3:4.00) vs on-pump 4.00 (Q1:3.00 to Q3:4.00), and the mean number of grafts per patient was lower in the off-pump CABG at 3.45 ± 0.75 vs 3.64 ± 0.70 in the on-pump CABG (p = 0.01). There was no significant difference in mortality at 3 months between the off-pump (0.63%) and on-pump groups (1.85%) with p value of 0.62. The cumulative combined MACCE showed significant difference between off-pump group (0.63%) and on-pump group (5.55%), p = 0.01. Follow-up angiograms were done in 239 (75%) patients with 120 off-pump and 119 in the on-pump group. The analysis was also done regarding graft patency in a graded manner-when analysis of A (excellent) grafts vs B (stenosed) grafts and O (occluded) grafts were made, there was no statistically significant difference in overall graft patency at 3 months between on-pump [376 /429 grafts (87.6%)] and off-pump [366 /420 grafts (87.1%)] groups (p = 0.82). The patency rates were similar among bypass conduits (left internal thoracic artery (ITA) in off-pump (91.4%) vs on-pump (92.9%) p = 0.66, right ITA in off-pump (82.1%) vs on-pump (81.8%) p = 0.97, radial artery in off-pump (84.4%) vs on-pump (82.6%) p = 0.81; saphenous vein in off-pump (85.8%) vs on-pump (86.3%), p = 0.86 and among 3 coronary territories.

Conclusions: Off-pump CABG is non-inferior to on-pump CABG in terms of overall graft patency at 3 months and was associated with a fewer combined cumulative MACCE compared to on-pump CABG.

Keywords: Coronary angiography; Coronary artery bypass grafting (CABG); Multidetector computerized tomographic angiography.

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Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Graft patency rates between off-pump and on-pump CABG
Fig. 3
Fig. 3
Overall graft patency showing patency rates of A vs B and O and A and B vs O
See this image and copyright information in PMC

References

    1. Shroyer AL, Grover FL, Hattler B, et al. On-pump versus off-pump coronary- artery bypass surgery. N Engl J Med. 2009;361:1827–1837. doi: 10.1056/NEJMoa0902905. - DOI - PubMed
    1. Mohr FW. To beat or not to beat? Form one size fits it all to an individual coronary revascularization strategy. Eur Heart J. 2010;31:2441–2443. doi: 10.1093/eurheartj/ehq257. - DOI - PubMed
    1. Khan NE, De Sousa A, Mister R, et al. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med. 2004;350:21–28. doi: 10.1056/NEJMoa031282. - DOI - PubMed
    1. Houlind K, Kjeldsen BJ, Madsen SN, et al. The impact of avoiding cardiopulmonary by-pass during coronary artery bypass surgery in elderly patients: the Danish On-pump Off-pump Randomisation Study (DOORS) Trials. 2009;10:47. doi: 10.1186/1745-6215-10-47. - DOI - PMC - PubMed
    1. Widimsky P, Straka Z, Stros P, et al. One year coronary bypass graft patency. A randomized comparison between off-pump and on-pump surgery. Angiographic results of the PRAGUE-4 trial. Circulation. 2004;110:3418–3423. doi: 10.1161/01.CIR.0000148139.79580.36. - DOI - PubMed

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