Randomized Trial Comparing Off-Pump to On-Pump Coronary Artery Bypass Grafting in High-Risk Patients ( # 2003-13903
Objective: The subset of patients most likely to benefit from off-pump coronary artery bypass grafting (CABG) remains a controversial issue, but the technique has been proposed to decrease postoperative mortality and morbidity. The objective of this study was to compare off-pump to on-pump CABG in patients with known risk factors for mortality and morbidity. 65 high-risk patients were prospectively randomized to undergo off-pump or on-pump CABG. Recruited patients had at least 3 of the following criteria: age greater than 65 years, high blood pressure, diabetes, serum creatinine greater than 133 ␮mol/L, left ventricular ejection fraction lower than 45%, chronic pulmonary disease, unstable angina, congestive heart failure, repeat CABG, anemia, and carotid atherosclerosis. Hospital mortality and morbidity were the primary end-points of the study. Results: Six patients (9%) crossed over from the original randomized group. Twenty-eight patients averaging 70 ± 8 years of age underwent 3 ± 1 grafts off pump, and 37 patients averaging 70 ± 6 years of age underwent 3.4 ± 1 grafts on pump. Revascularization was considered complete in 21 (75%) of off-pump patients compared to 33 (89%) of on-pump patients (P = .1). There were no hospital deaths in off-pump patients, and 2 patients (5%) undergoing on-pump CABG died early following surgery (P = .2). Two off-pump (7%) compared to 11 on-pump (30%) of patients presented composite end-points including death, neurolog-ical injury, renal failure, respiratory failure, and operative myocardial infarction after CABG (P = .02). Conclusion: The present study suggests that off-pump CABG, when technically feasible, significantly reduces morbidity following surgery in a group of high-risk patients. Coronary artery bypass grafting (CABG) is currently performed with or without the use of the cardiopulmonary bypass system (CPB). Although both techniques are being used with success [Van Dijk 2001], a debate is raging between advocates and opponents of off-pump CABG about patient outcomes and surgical indications for one or the other technique [Bonchek 2002]. Several authors have suggested that off-pump CABG could be especially useful and effective in improving clinical outcomes in high-risk patients who require surgical revascu-larization [Hoff 2002, Al-Ruzzeh 2003]. Elderly patients and those with significant comorbidities are more susceptible to the deleterious effects of CPB and are most likely to benefit from the use of off-pump CABG compared to the standard on-pump approach [Demaria 2002]. The objective of the present study was to compare outcomes between off-pump CABG and a standard technique of CABG with …