Clinical and Radiologic Outcome of Off-Pump Coronary Surgery at 12 Months Follow-Up: A Prospective Randomized Trial

Lingaas, Per Snorre; Hol, Per Kristian; Lundblad, Runar; Rein, Kjell Arne; Mathisen, Lars; Smith, Hans‐Jørgen; Andersen, Rune; Thaulow, Erik; Tønnesen, Tor; Svennevig, Jan; Hauge, Sigurd Nitter; Fredriksen, Per Morten; Andersen, Marit Helen; Fosse, Erik

doi:10.1016/j.athoracsur.2005.12.003

Cited by 84 publications

(72 citation statements)

References 24 publications

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“…This absolute difference is comparable to those in other trials that have reported absolute differences ranging from 4.0% to 10.0%, all favoring on-pump CABG. 6,9,10,18,19 The 1-year patency rates for arterial and SVG conduits in ROOBY compare favorably with other reports, supporting the quality and expertise of the participating surgeons. 16,20,21 Complete revascularization is always the ideal goal of a CABG procedure.…”

Section: Discussionsupporting

confidence: 72%

“…A direct comparison of the quality of arterial patency in the ROOBY trial and other studies is difficult because most other studies have reported only the combined FitzGibbon A and B patency rates or the open graft rate, failing to make the important distinction between the widely patent FitzGibbon A graft and the flow-limited, stenotic FitzGibbon B graft. 4,6,9,10,18,19 The absolute difference in SVG patency between arms was 7.2% better with on-pump CABG (PϽ0.001). This absolute difference is comparable to those in other trials that have reported absolute differences ranging from 4.0% to 10.0%, all favoring on-pump CABG.…”

Section: Discussionmentioning

confidence: 99%

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Off-Pump Coronary Artery Bypass Surgery Is Associated With Worse Arterial and Saphenous Vein Graft Patency and Less Effective Revascularization

Hattler

Messenger²,

Shroyer³

et al. 2012

Circulation

210

111

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Off-Pump Coronary Artery Bypass Surgery Is Associated With Worse Arterial and Saphenous Vein Graft Patency and Less Effective Revascularization

Hattler

Messenger²,

Shroyer³

et al. 2012

Circulation

210

111

View full text Add to dashboard Cite

“…The majority of the randomised studies were ranked at Level 2 (moderate quality) with four studies at Level 3 (high quality) [21,23,29,31]. The 3 PSM studies [32 -34] were ranked at Level 1 (low quality).…”

Section: Selected Studiesmentioning

confidence: 99%

Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited

Athanasiou¹

2004

European Journal of Cardio-Thoracic Surgery

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Atrial fibrillation (AF) is the most common post-operative complication in patients undergoing coronary artery bypass grafting, with an increased incidence associated with advancing age. This study aims to determine whether off-pump coronary artery bypass (OPCAB) reduces the incidence of AF in a generalized population (mean age <70 years). A meta-analysis was performed including all randomised and propensity score matched non-randomised studies published between 2001 and 2003 reporting a comparison between the two techniques in a generalised patient group (average age <70 years). The primary outcome of interest was post-operative AF. Sensitivity analysis was performed to evaluate consistency of the calculated treatment effect. Fourteen studies fulfilled our inclusion criteria, including a total of 16,505 subjects. The incidence of AF was 19% (1612/8265) in the off-pump group versus 24% (1976/8240) in the on-pump group. When considering only the 11 randomised studies (2207 subjects), we found a significant reduction in the incidence of post-operative AF in the off-pump group using a random-effect model (odds ratio (OR)=0.60, 95% confidence interval (CI)=0.45-0.82, and chi-square of heterogeneity=18.02, P=0.05). Sensitivity analysis highlighted one randomised study causing funnel plot asymmetry, exclusion of which resulted in a significant reduction in the incidence of post-operative AF in the off-pump group (OR=0.71, 95% CI=0.57-0.90), with a non-significant heterogeneity of 3.91 (P=0.92). When only studies of high quality were considered (898 patients), no significant difference was seen between on and off-pump groups (OR=0.78, 95% CI=0.57-1.07, and heterogeneity=0.53, P=0.91). This may be due to small number of patients in this group. Our results suggest that although OPCAB surgery may reduce the incidence of post-operative AF in a generalised population (age <70 years) this finding is not clearly supported by high quality randomised trials. Although previous evidence suggests that the incidence of post-operative AF is reduced in an elderly population (>70 years) with off-pump surgery, our results show that the evidence is less clear in a younger population group. The question of whether off-pump surgery in this patient group results in a lower rate of post-operative AF remains to be answered by further high quality randomised research.

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“…A significantly lowered patency for saphenous vein grafts than for internal thoracic artery grafts was suggested to result from the type of graft, presence of hyperlipidemia, the exposure and quality of stabilization, and increased procoagulant activity in OPCAB patients [6,11]. Although some studies demonstrated similar early vein graft patencies between OPCAB and conventional CABG [12][13][14], other meta-analysis using five randomized studies showed that OPCAB significantly increased the risk of graft failure, with the odds of graft occlusion 51% higher within the first postoperative year [5]. Those differences were mainly attributable to the lower saphenous vein or radial artery graft patency rate.…”

Section: Discussionmentioning

confidence: 98%

Influence of vein graft use on postoperative 1-year results after off-pump coronary artery bypass surgery

Cho

Jeong

Kim

2007

European Journal of Cardio-Thoracic Surgery

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Objective: We studied the postoperative 1-year results after off-pump coronary artery bypass surgery (OPCAB) with one or more saphenous vein grafts. Methods: We compared the clinical and angiographic results of 833 patients who underwent OPCAB between 1998 and 2004. Group 1 patients (n = 135) received one or more vein grafts. Group 2 patients (n = 698) received total arterial grafts. Coronary angiographies were performed early postoperatively (n = 804, 1.6 AE 1.5 days), and 1 year postoperatively (n = 671, 12.1 AE 4.2 months). Results: There were no significant differences in patient characteristics, operative mortalities, and morbidities between the two groups ( p = ns). Both the early postoperative and 1-year angiographies demonstrated significantly lower overall graft patency rates in group 1 than in group 2 (early: 90.9% vs 99.1%, p < 0.001; 1 year: 78.8% vs 95.1%, p < 0.001), which might be affected by the lower vein graft patency rates in group 1 (early: 86.4%; 1 year: 67.9%). There was no difference in the 1-year patency of internal thoracic arteries between the two groups (94.3% vs 95.6%, p = 0.402). Multivariate analysis demonstrated the use of vein graft (Odds ratio = 5.204, p < 0.001) as an independent predictor of graft failure during the first postoperative year. Target vessel revascularization rate during the postoperative 1 year was significantly higher in group 1 than in group 2 (7.4% vs 2.0%, p = 0.002). Conclusions: Our study revealed that saphenous vein graft use in OPCAB independently predicted the graft failure while increasing the target vessel revascularization rate during the first postoperative year. Exclusive arterial revascularization would be a preferable strategy in OPCAB. #

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Clinical and Radiologic Outcome of Off-Pump Coronary Surgery at 12 Months Follow-Up: A Prospective Randomized Trial

Cited by 84 publications

References 24 publications

Off-Pump Coronary Artery Bypass Surgery Is Associated With Worse Arterial and Saphenous Vein Graft Patency and Less Effective Revascularization

Off-Pump Coronary Artery Bypass Surgery Is Associated With Worse Arterial and Saphenous Vein Graft Patency and Less Effective Revascularization

Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited

Influence of vein graft use on postoperative 1-year results after off-pump coronary artery bypass surgery

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