Off-Pump and On-Pump Heart Bypass Outcomes Compared

Study finds off-pump patients have poorer long term outcomes, vascularization and graft patency

WEDNESDAY, Nov. 4 (HealthDay News) -- Coronary artery bypass graft surgery (CABG) performed with cardiopulmonary bypass support (on-pump) produced better results after one year than CABG performed without bypass support (off-pump), according to a study in the Nov. 5 New England Journal of Medicine.

A. Laurie Shroyer, Ph.D., of the Northport Veterans Affairs Medical Center in New York, and colleagues randomized 2,203 subjects scheduled for CABG to undergo the procedure either on-pump or off-pump. The primary study end point in the short term (30 days) was a composite measure, including death and complications such as cardiac arrest, stroke, required mechanical support, required reoperation, or renal failure. Long term (one year) primary end points were death, repeat revascularization, or non-fatal heart attack. Secondary outcomes included revascularization completeness, patency, neuropsychological status, and major resources utilized.

The investigators found no significant difference in the composite outcome between on-pump and off-pump subjects in the short term, but, at one year, the off-pump group had a higher rate for the composite outcome (9.9 percent) than the on-pump group (7.4 percent). Also, more patients in the off-pump group had fewer grafts than planned (17.8 versus 11.1 percent) and the overall graft patency was lower in the off-pump group (82.6 versus 87.8 percent).

"At one year follow-up, patients in the off-pump group had worse composite outcomes and poorer graft patency than did patients in the on-pump group. No significant differences between the techniques were found in neuropsychological outcomes of use of major resources," the authors write.

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