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Off-Pump CABG Clears Another Hurdle

Nonrandomized studies in selected patients have documented similar in-hospital outcomes and graft patency with on-pump and off-pump (beating-heart) coronary artery bypass grafting (CABG), but shorter hospital stays with the off-pump procedure. In a recent randomized trial, 3-month graft patency was significantly better with on-pump than with off-pump CABG, but less surgeon experience with the off-pump procedure could have played a role (Journal Watch Cardiology Feb 6 2004).

In a new, partly industry-supported, randomized trial of on-pump versus off-pump CABG at one academic center, researchers enrolled patients unselected for coronary anatomy, ventricular function, or comorbidities. Of 297 patients screened, 200 were randomized. A surgeon experienced in both types of CABG performed the surgeries. Patients were subsequently managed according to blinded protocols.

At both 30 days and 1 year, the two groups had similar rates of graft patency, death, stroke, MI, angina, and reintervention, and they had similar 1-year health-related quality-of-life scores. Total hospitalization costs per patient were a significant $2272 lower with off-pump CABG by initial hospital discharge and a marginally significant $1955 lower by 1 year.

Comment: In this randomized trial among unselected patients who underwent elective surgery, off-pump CABG at the hands of an experienced surgeon at an academic center yielded 30-day and 1-year graft patency, cardiac outcomes, and health-related quality of life that were similar to those for on-pump CABG -- and at a lower cost. The applicability to other settings must be explored in larger, multicenter randomized trials.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology December 31, 2004

Citation(s):

Puskas JD et al. Off-pump vs conventional coronary artery bypass grafting -- Early and 1-year graft patency, cost, and quality-of-life outcomes: A randomized trial. JAMA 2004 Apr 21; 291:1841-9.

• Original article (Subscription may be required)
• Medline abstract (Free)

Peterson ED and Mark DB. Off-pump bypass surgery -- Ready for the big dance? JAMA 2004 Apr 21; 291:1897-9.

• Original article (Subscription may be required)
• Medline abstract (Free)