Off-Pump and On-Pump Coronary Artery Bypass Grafting Are Associated With Similar Graft Patency, Myocardial Ischemia, and Freedom From Reintervention: Long-Term Follow-Up of a Randomized Trial

Puskas, John D.; Williams, Willis H.; O'Donnell, Robert D.; Patterson, Randolph E.; Sigman, Steven R.; Smith, Alexander C.; Baio, Kim T.; Kilgo, Patrick D.; Guyton, Robert A.

doi:10.1016/j.athoracsur.2010.12.043

Cited by 147 publications

(106 citation statements)

References 19 publications

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“…In this trial, there were no differences in late survival, 1-year graft patency (93.6% for OPCAB vs. 95.8% for ONCAB, P=0.33), recurrent angina or repeat revascularization (8).…”

Section: Overview Of the Opcab Randomized Controlled Trial (Rct) Litementioning

confidence: 60%

The future of off-pump coronary artery bypass grafting: a North American perspective

2016

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Off-pump coronary artery bypass graft (OPCAB) is currently performed routinely in a minority of specialized centers and in many more centers, utilized only when a porcelain aorta mandates a no-touch aortic technique. The OPCAB literature can be summarized as follows: (I) large-scale randomized trials in relatively low risk patients that include surgeons with a range of experience demonstrating no consistent beneficial differences in major cardiovascular and cerebrovascular outcomes but lower transfusion rates and shorter length of stay, tempered by some reports of higher rates of incomplete revascularization and lower rates of long term graft patency; (II) smaller randomized controlled trials (RCTs) from highly specialized programs demonstrating equivalent or superior outcomes with OPCAB and similar completeness of revascularization and graft patency; and (III) observational data from large databases demonstrating a consistent benefit of OPCAB, especially in higher-risk patient subsets. Our rationale for OPCAB remains that if complete and precise revascularization can be safely and routinely accomplished, then the patient should benefit by avoiding the morbidities that can be attributed to aortic cannulation/clamping, cardiopulmonary bypass (CPB), hemodilution, hypothermia and global myocardial ischemia/cardioplegia.We further believe that OPCAB procedures should emphasize the use of arterial grafts to optimize long term patency and minimize aortic manipulation to limit the risk of stroke. Moving forward, the off-pump surgical community and specialty societies must address the challenge of training surgeons and their teams to master this technically demanding procedure. Furthermore, OPCAB opens the door to minimally-invasive surgical revascularization via hybrid coronary revascularization (HCR). A large NIH-funded RCT is currently underway to determine whether hybrid revascularization can offer a superior alternative to multi-vessel percutaneous coronary intervention for patients with low SYNTAX score and proximal LAD disease.

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“…In this trial, there were no differences in late survival, 1-year graft patency (93.6% for OPCAB vs. 95.8% for ONCAB, P=0.33), recurrent angina or repeat revascularization (8).…”

Section: Overview Of the Opcab Randomized Controlled Trial (Rct) Litementioning

confidence: 60%

The future of off-pump coronary artery bypass grafting: a North American perspective

2016

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“…The most notable merits, as suggested by several observational studies, included avoiding embolic stroke caused by invasive aortic manipulation and reducing coagulopathy and renal dysfunction (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). However, the expected benefit on long term survival is still debated.…”

Section: Discussionmentioning

confidence: 99%

“…This has triggered a large number of randomized clinical trials (RCTs) and retrospective analyses addressing the clinical outcomes of the two techniques. There seems to be convincing evidence that OPCAB reduces the risk of early postoperative morbidity such as myocardial infarction, pulmonary dysfunction, abnormal renal function, atrial fibrillation, blood product transfusion, intensive care unit and hospital stay (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). However, concerns persist with respect to the impact of OPCAB on long-term mortality…”

Section: Introductionmentioning

confidence: 99%

Impact of off-pump coronary artery bypass grafting on survival: current best available evidence

et al. 2016

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Abstract:The superiority of either off-pump (OPCAB) or on-pump (ONCAB) coronary artery bypass grafting (CABG) remains unclear despite a large body of literature evidence comparing the two approaches.The potential advantages of avoiding cardiopulmonary bypass (CPB), minimizing aortic manipulation and maintaining pulsatile flow may be associated with reduced inflammatory responses and embolic events.Numerous studies compared OPCAB with ONCAB and the cumulative data have been presented in metaanalyses of both randomized and observational studies. Although there is an abundance of data with respect to the operative morbidity and mortality and the short-term outcomes associated with these two strategies, not much is known about how they impact long-term survival and recurrence of myocardial ischaemic events. Recent studies and meta-analyses have focused on long-term survival and major secondary outcomes in OPCAB vs. ONCAB within the general population. Significant limitations in methodology, however, have raised concerns about the strength of several randomized trials with restrictive inclusion criteria that reduced the populations to those at low risk only, thus creating result bias. Here, we present a review of the best available evidence with a focus on long-term outcomes.

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“…A smaller single‐institution and single‐surgeon RCT reported similar angiographic outcomes with the 2 techniques 80. A Japanese RCT including 167 consecutive patients found no difference in patency but a numerically higher perfect patency rate in the on‐pump group (96% versus 93%; P =0.09), particularly for grafts to the right coronary system (99% versus 90%; P =0.02) 81.…”

Section: Opcab and Graft Patencymentioning

confidence: 90%

Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

Gaudino

Angelini

Antoniades

et al. 2018

JAHA

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Off-Pump and On-Pump Coronary Artery Bypass Grafting Are Associated With Similar Graft Patency, Myocardial Ischemia, and Freedom From Reintervention: Long-Term Follow-Up of a Randomized Trial

Cited by 147 publications

References 19 publications

The future of off-pump coronary artery bypass grafting: a North American perspective

The future of off-pump coronary artery bypass grafting: a North American perspective

Impact of off-pump coronary artery bypass grafting on survival: current best available evidence

Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

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