Off-Pump Coronary Artery Bypass Grafting is Associated with Reduced Operative Mortality and In-Hospital Adverse Events in Patients with Left Main Coronary Artery Disease

Sarin, Eric L.; Puskas, John D.; Kilgo, Patrick D.; Thourani, Vinod H.; Guyton, Robert A.; Lattouf, Omar M.

doi:10.1097/imi.0b013e3181a20da6

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“…With regard to short-term stroke risk, a metaanalysis of 59 randomized trials (n = 8,961) associated OPCAB with a 30 % reduction in 30-day stroke risk [ 107 ]. This is consistent with the results of two large, propensitymatched registry studies (CREDO-Kyoto [ 111 ] [n = 6,323] and a 2008 study by Puskas et al [ 104 ] [n = 12,812]) and a large retrospective study (n = 13,108) [ 105 ], all of which showed lower short-term stroke rates in OPCAB patients than in CABG patients. In contrast, the ROOBY trial [ 109 ], the CORONARY trial [ 98 ], and a very large (n = 63,047) Veterans Administration registry study [ 108 ] found no differences in short-term stroke rates.…”

Section: Results Of Off-pump Coronary Artery Bypasssupporting

confidence: 83%

Surgical Treatment of Coronary Artery Disease

Cohn

Frazier

Mallidi

et al. 2015

Cardiovascular Medicine

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Techniques and technology for treating coronary artery disease (CAD) have evolved significantly over the past 50 years. Although there are cases in which the best treatment approach (medical, surgical, or catheter-based) is clear, the best choice of intervention is not obvious for the majority of patients. Five, seven, and ten years after initial treatment, mortality is lower for coronary artery bypass grafting (CABG) than for medical treatment alone. The survival benefi ts of CABG are particularly substantial for patients with 3-vessel or left main artery disease, severe angina, or a positive pretreatment exercise stress test.Most trials that have compared CABG with percutaneous coronary intervention (PCI) in patients with multivessel disease have shown similar short-term survival benefi ts, but PCI has been associated with less periprocedural morbidity, including stroke, whereas CABG has been associated with longer-lasting revascularization.Technical innovations made in the attempt to reduce the negative impact of cardiopulmonary bypass (CPB) include reducing contact between blood and the CPB mechanism by coating the internal surface with heparin or other polymers, minimizing hemodilution by shrinking the bypass circuit to reduce the amount of crystalloid prime needed to start CPB, and using hemofi ltration to protect the heart and end organs. There is not yet complete agreement about the relative safety and effi cacy of off-pump coronary artery bypass (OPCAB) versus conventional CABG with CPB.Results of small randomized trials suggest that, in patients with stenosis of the proximal LAD, minimally invasive direct coronary artery bypass (MIDCAB) is associated with a longer in-hospital recovery period and higher costs than is direct stenting, but that MIDCAB produces similar or better short-and long-term outcomes. Totally endoscopic coronary artery bypass (TECAB) aided by computer-controlled surgical robotic devices has continued to slowly evolve over the last decade, and several centers have reported favorable results. The technical challenges and procedural costs have prevented the widespread application of this technology. • Techniques and technology for treating coronary artery disease (CAD) have evolved signifi cantly over the past 50 years.• Although there are cases in which the best treatment approach (medical, surgical, or catheterbased) is clear, the best choice of intervention is not obvious for the majority of patients.• Five, 7, and 10 years after initial treatment, mortality is lower for coronary artery bypass grafting (CABG) than for medical treatment alone. The survival benefi ts of CABG are particularly substantial for patients with 3-vessel or left main artery disease, severe angina, or a positive pretreatment exercise stress test.• Most trials that have compared CABG with percutaneous coronary intervention (PCI) in patients with multivessel disease have shown similar shortterm survival benefi ts, but PCI has been associated with less periprocedural morbidity, including stroke, whereas CA...

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