Off-pump coronary artery bypass grafting shows lower perioperative morbidity, mortality than on-pump

Perioperative morbidity and mortality are slightly reduced with coronary artery bypass grafting (CABG) performed off-pump (OPCAB) by experienced surgeons, according to a study presented at the annual meeting of the Society of Thoracic Surgeons, held from Jan. 29 to Feb. 1 in New Orleans.

John Puskas, M.D., from Emory University Hospital Midtown in Atlanta, and colleagues examined the short-, intermediate-, and long-term outcomes after isolated OPCAB versus on-pump CABG (ONCAB), both performed by experienced high-volume surgeons. The primary end point was 0- to 15-year all-cause mortality.

The study included 184,655 OPCAB cases performed by 205 experienced OPCAB surgeons and 1,340,404 ONCAB cases performed by 1,566 experienced ONCAB surgeons. A total of 184,550 very closely matched pairs were included in a greedy propensity score-matching analysis. The researchers found that incomplete revascularization occurred more often with OPCAB (14.4% versus 8.1%); an average of 0.20 fewer grafts were received by OPCAB patients. In OPCAB, multiarterial grafting was more frequent (14.5% versus 9.6%); an average of 0.10 more arterial grafts were received by OPCAB patients.

Significantly better perioperative/30-day outcomes were experienced by OPCAB versus ONCAB patients, including operative mortality, stroke, new atrial fibrillation, renal failure, return to the operating room, prolonged ventilation, and any transfusion. A gradual diminishing return of the early OPCAB survival advantage was seen with follow-up through five years. For patients with one-vessel disease, but not for those with multivessel disease, a small OPCAB survival advantage reappeared through 15-year follow-up.

“Our results emphasize the importance of surgeon experience, complete revascularization, and use of multiple arterial grafts—regardless of surgical technique,” Puskas said in a statement.

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