Off-pump and On-Pump CABG both have Comparable Survival with Potential Benefits in Myocardial Protection
A recent observational analysis compared the choice of
surgical techniques like off-pump (OPCABG) and on-pump (ONCABG) coronary artery
bypass grafts and found that both OPCABG and ONCABG procedures are safe to
perform and have a good prognosis as per the results published in the journal
Annals of Medicine and Surgery.
Coronary artery bypass grafting (CABG) is the most common
cardiac surgery procedure despite several percutaneous procedures. Due to their
pros and cons, there has been long ambiguity on the efficiency of on-pump
(ONCABG) and off-pump (OPCABG) CABG methods. OPCABG is complex requires a
skilled surgeon and compromises the technical performance of the surgeon, while
ONCABG requires a heart-lung machine. Hence, researchers from the University
Hospital and the University of Turku, Finland conducted a study to determine which
surgical technique affects prognosis in coronary artery bypass grafting (CABG).
They performed a single-center, retrospective observational
study on all the off-pump (OPCABG) and on-pump (ONCABG) patients at Turku
University Central Hospital. Patients who underwent concomitant valve surgery
and re-operative CABG were excluded. The main outcome of measurement was the length
of stay in the intensive care unit (ICU), need for resternotomy, perioperative
mortality, and 1-year mortality.
Statistical analyses were performed with R 4.0.2 software. Numerical
variables between ONCABG and OPCABG groups were compared using the Mann-Whitney
U test. One-to-one propensity score matching was used to account for bias in
patient selection.
Findings:
- Out of 217 CABG patients operated, 86 were OPCABG.
- The mean (SD) age of all patients was 68,3 (9,2) years and
15,7% were women. - The perioperative, 1-year, and 3-year mortality did not
differ between the groups after propensity score matching. - The ONCABG patients received more allogenic red blood cells
(1.3 vs. 0.6 units, p = 0.020), autologous red blood cells (564 vs. 285 ml, p
< 0.001) and crystalloids (3388 vs. 2808 ml, p < 0.001), and had higher
postoperative values of troponin T (581 vs. 222, p = 0.001) and lactate (1.69
vs. 1.23, p < 0.001) than the OPCABG patients.
Thus, the study concluded that surgical outcomes were
equally good between the two groups at 1-year and 3-year follow-ups. Despite low-risk
profiles and preoperative characteristics, the ONCABG patients received more
often red blood cells and higher amounts of crystalloids and had higher
postoperative TnT and lactate values. They also suggested that the OPCABG
technique may be particularly suitable for frail patients due to milder myocardial
damage and more balanced postoperative hemodynamics.
Further reading: Rantanen M, Yousif R, Kallioinen M, et al. Retrospective observational analysis of a coronary artery bypass grafting surgery patient cohort: Off-pump versus on-pump. Ann Med Surg (Lond). 2022;84:104812. Published 2022 Nov 9. doi:10.1016/j.amsu.2022.104812
