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ABSTRACT

Background The effect of the use of coronary-artery bypass surgery without cardiopulmonary bypass and cardiac arrest ("off pump") on graft patency remains uncertain. We undertook a prospective, randomized, controlled study to compare graft-patency rates and clinical outcomes in off-pump surgery with conventional, "on-pump" surgery.

Methods We randomly assigned 50 patients to undergo on-pump coronary-artery bypass grafting and 54 to undergo off-pump surgery. Surgical and anesthetic techniques were standardized for both groups. Clinical outcomes and troponin T levels were measured. Three months later, the patients underwent coronary angiography, including quantitative analysis.

Results The mean age of the patients was 63 years, and 87 percent were men. The on-pump group received a mean of 3.4 grafts, and the off-pump group 3.1 (P=0.41). There were no deaths. There was no significant difference in the median postoperative length of stay between the two groups (seven days in each group). The area under the curve of troponin T levels was higher during the first 72 hours in the on-pump group than in the off-pump group (30.96 hr • µg per liter vs. 19.33 hr • µg per liter, P=0.02). At three months, 127 of 130 grafts were patent in the on-pump group (98 percent), as compared with 114 of 130 in the off-pump group (88 percent, P=0.002). The patency rate was higher for all graft territories in the on-pump group than in the off-pump group.

Conclusions In this randomized study, off-pump coronary surgery was as safe as on-pump surgery and caused less myocardial damage. However, the graft-patency rate was lower at three months in the off-pump group than in the on-pump group, and this difference has implications with respect to the long-term outcome.

Source Information

From the Royal Brompton and Harefield National Health Service Trust (N.E.K., A.D.S., R.M., M.F., J.C., S.D.); the Imperial College of Science, Technology, and Medicine, National Heart and Lung Institute (P.C., J.P.); and the London School of Hygiene and Tropical Hygiene (D.W.) — all in London; and the Center and Division of Cardiology, University Hospital, Geneva (U.S.).

Address reprint requests to Dr. Khan at the Clinical Trials and Evaluation Unit, Royal Brompton Hospital, London SW3 6NP, United Kingdom, or at r.mister{at}rbh.nthames.nhs.uk.

Full Text of this Article

Related Letters:

Off-Pump versus On-Pump Coronary Bypass Surgery
deGuzman B. J., Subramaniam M. H., Dewey T. M., Magee M. J., Mack M. J., Desai N. D., Fremes S. E., Svedjeholm R., Dahlin L.-G., Khan N. E., DeSouza A. C., Pepper J. R.
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N Engl J Med 2004; 350:1791-1793, Apr 22, 2004. Correspondence

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