Both off-, on-pump CABG can be performed in high-risk patients with low, short-term complications

Off-pump coronary artery bypass grafting appears to be a safe procedure in high-risk patients, and was associated with no significant difference in 30-day mortality and other outcomes compared with on-pump CABG, in a new study.

Researchers compared 30-day outcomes in 341 high-risk patients with three-vessel coronary disease and a EuroSCORE >5 randomly assigned to CABG with or without cardiopulmonary bypass. Off-pump surgery was performed using Octopus and Starfish heart stabilizers (Medtronic) and on-pump surgery was performed in normothermia, using aortic cross-clamping and cold cardioplegic arrest. After discharge from the Best Bypass Study, patients were followed through the Danish National Patient Registry. Baseline characteristics were similar between the two groups. Five patients were aged younger than 65 years; about 20% had diabetes; more than one-third were women; and mean EuroSCORE was 6.9.

The mean number of grafts per patient was similar between the off-pump (3.22) and on-pump (3.34) groups (P=.11). During off-pump surgery, fewer grafts were performed to the lateral part of the left ventricle territory (0.97) vs. on-pump surgery (1.14; P=.01).

The researchers noted that the primary outcome — a composite of adverse cardiac and cerebrovascular events — was not influenced by type of operation (P=.48), nor were the individual components at 30-day follow-up.

Postoperative complications occurred at a high rate in high-risk patients; however, off-pump CABG was not associated with a significant reduction in postoperative morbidity, according to the researchers.

“Any expected short-term benefits from off-pump CABG were not evidence from this trial,” the researchers concluded. “Off-pump CABG may carry a risk of incomplete revascularization of the lateral territory of the left ventricle, which could affect long-term prognosis.”

Møller CH. Circulation. 2010;121:498-504.