Skip to main content
SpringerLink
Log in

Comparison of off-pump and on-pump coronary artery bypass grafting in midterm results

  • Original Article
  • Published:
The Japanese Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective: Off-pump coronary artery bypass grafting (OPCAB) has become a procedure of choice for surgical treatment of coronary artery disease. Although early advantages of OPCAB were confirmed in comparison with conventional on-pump coronary artery bypass grafting (CABG), late cardiac complications are still controversial. We examined midterm results of OPCAB compared with standard CABG. Methods: Between July 1997 and April 2002, 736 consecutive patients who underwent isolated CABG were retrospectively reviewed. The OPCAB group (Group I) comprised 357 patients (49%), and the on-pump CABG group (Group II) 379 patients (51%). Their preoperative, intraoperative, and follow-up data were analyzed. Results: The mean number of distal anastomoses and the early graft patency were not greatly different between the two groups. The actuarial survival rate at 3 years was not significantly different between Group I (98.3%) and Group II (98.2%) (p=0.71). The frequency of cardiac events was 4.2%/patient-year in Group I and 2.6%/patient-year in Group II (p=0.12). The actuarial event free rates were not different between the two groups (p=0.61). The cardiac event free rates at 3 years were significantly (p=0.011) higher in patients with complete revascularization (96.7%) than without complete revascularization in Group I (69.2%) and in Group II (92.7% versus 85.9%, p=0.026). Conclusions: Midterm clinical outcome in OPCAB is as good as conventional on-pump CABG. Incomplete revascularization caused cardiac events more frequently than complete revascularization both in OPCAB and on-pump CABG in the intermediate follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lee JH, Abdelhady K, Capdeville M. Clinical outcomes and resource usage in 100 consecutive patients after off-pump coronary bypass procedures. Surgery 2000; 128: 548–55.

    Article  PubMed  CAS  Google Scholar 

  2. Oliveira SA, Lisboa LA, Dallan LA, Rojas SO, Poli de Figueiredo LF. Minimally invasive single-vessel coronary artery bypass ih the internal thoracic artery and early postoperative angiography: Midterm results of a prospective study in 120 consecutive patients. Ann Thorac Surg 2002; 73: 505–10.

    Article  PubMed  Google Scholar 

  3. Bell MR, Gersh BJ, Schaff HV, Holmes DR Jr, Fisher LD, Alderman EL, et al. Effect of completeness of revascularization on long-term outcome of patients with three-vessel disease undergoing coronary artery bypass surgery. A report from the Coronary Artery Surgery Study (CASS) Registry. Circulation 1992; 86: 446–57.

    PubMed  CAS  Google Scholar 

  4. Bertelsen CA, Kjøller M, Høier-Madsen K, Folke K, Fritz-Hansen P. Influence of complete revascularization on long-term survival after coronary artery bypass surgery. Scand Cardiovasc J 1997; 31: 271–4.

    PubMed  CAS  Google Scholar 

  5. Cukingnan RA, Carey JS, Witting JH, Brown BG. Influence of complete coronary revascularization on relief of angina. J Thorac Cardiovasc Surg 1980; 79: 188–93.

    PubMed  CAS  Google Scholar 

  6. Tyras DH, Barner HB, Kaiser GC, Codd JE, Laks H, Pennington DG, et al. Long-term results of myocardial revascularization. Am J Cardiol 1979; 44: 1290–6.

    Article  PubMed  CAS  Google Scholar 

  7. Jones EL, Weintraub WS. The importance of completeness of revascularization during long-term follow-up after coronary artery operations. J Thorac Cardiovasc Surg 1996; 112: 227–37.

    Article  PubMed  CAS  Google Scholar 

  8. Schaff HV, Gersh BJ, Pluth JR, Danielson GK, Orszulak TA, Puga FJ, et al. Survival and functional status after coronary artery bypass grafting: Results 10 to 12 years after surgery in 500 patients. Circulation 1983; 68: II200–4.

    PubMed  CAS  Google Scholar 

  9. Cosgrove DM, Loop FD, Lytle BW, Gill CC, Golding LA, Gibson C, et al. Determinants of 10-year survival after primary myocardial revascularization. Ann Surg 1985; 202: 480–90.

    Article  PubMed  CAS  Google Scholar 

  10. Lawrie GM, Morris GC Jr, Earle N. Long-term results of coronary bypass surgery. Analysis of 1698 patients followed 15 to 20 years. Ann Surg 1991; 213: 377–87.

    Article  PubMed  CAS  Google Scholar 

  11. Kobayashi J, Sasako Y, Bando K, Niwaya K, Tagusari O, Nakajima H, et al. Multiple off-pump coronary revascularization with “aorta no-touch” technique using composite and sequential methods. Heart Surg Forum 2002; 5: 114–8.

    PubMed  Google Scholar 

  12. D’Arrigo G, Scolaro A, Lomeo A. Off-pump myocardial revascularization. The single-suture technique: How to avoid any complication. Heart Surg Forum 2002; 6: E10–1.

    PubMed  Google Scholar 

  13. Ferguson TB Jr, Hammill BG, Peterson ED, DeLong ER, Grover FL. A decade of change-risk profile and outcomes for isolated coronary artery bypass grafting procedures, 1990–1999: A report from the STS National Database Committee and the Duke Clinical Research Institute. Society of Thoracic Surgeons. Ann Thorac Surg 2002; 73: 480–90.

    Article  PubMed  Google Scholar 

  14. Arom KV, Flavin TF, Emery RW, Kshettry VR, Janey PA, Petersen RJ. Safety and efficacy of off-pump coronary artery bypass grafting. Ann Thorac Surg 2000; 69: 704–10.

    Article  PubMed  CAS  Google Scholar 

  15. Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): A pooled analysis of two randomised controlled trials. Lancet 2002; 359: 1194–9.

    Article  PubMed  Google Scholar 

  16. Ishida M, Kobayashi J, Tagusari O, Bando K, Niwaya K, Nakajima H, et al. Perioperative advantages of off-pump coronary artery bypass grafting. Circ J 2002; 66: 795–9.

    Article  PubMed  Google Scholar 

  17. Cooley DA. Con: Beating-heart surgery for coronary revascularization: Is it the most important development since the introduction of the heart-lung machine? Ann Thorac Surg 2000; 70: 1779–81.

    Article  PubMed  CAS  Google Scholar 

  18. Gundry SR, Romano MA, Shattuck OH, Razzouk AJ, Bailey LL. Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmo-nary bypass. J Thorac Cardiovasc Surg 1998; 115: 1273–8.

    Article  PubMed  CAS  Google Scholar 

  19. Subramanian VA, McCabe JC, Geller CM. Minimally invasive direct coronary artery bypass grafting: Two-year clinical experience. Ann Thorac Surg 1997; 64: 1648–53.

    Article  PubMed  CAS  Google Scholar 

  20. Poirier NC, Carrier M, Lesperance J, Cote G, Pellerin M, Perrault LP, et al. Quantitative angiographic assessment of coronary anastomoses performed without cardiopulmonary bypass. J Thorac Cardiovasc Surg 1999; 117:292–7.

    Article  PubMed  CAS  Google Scholar 

  21. Amano A, Hirose H, Takahashi A, Nagano N. Coronary artery bypass grafting using the radial artery: Midterm results in a Japanese institute. Ann Thorac Surg 2001; 72: 120–5.

    Article  PubMed  CAS  Google Scholar 

  22. Vander Salm TJ, Kip KE, Jones RH, Schaff HV, Shemin RJ, Aldea GS, et al. What constitutes optimal surgical revascularization? Answers from the Bypass Angioplasty Revascularization Investigation (BARI). J Am Coll Cardiol 2002; 39: 565–72.

    Article  Google Scholar 

  23. Sabik JF, Gillinov AM, Blackstone EH, Vacha C, Houghtaling PL, Navia J, et al. Does off-pump coronary surgery reduce morbidity and mortality? J Thorac Cardiovasc Surg 2002; 124: 698–707.

    Article  PubMed  Google Scholar 

  24. Scott R, Blackstone EH, McCarthy PM, Lytle BW, Loop FD, White JA, et al. Isolated bypass grafting of the left internal thoracic artery to the left anterior descending coronary artery: Late consequences of incomplete revascularization. J Thorac Cardiovasc Surg 2000; 120: 173–84.

    Article  PubMed  CAS  Google Scholar 

  25. Anyanwu AC, Al-Ruzzeh S, George SJ, Patel R, Yacoub MH, Amrani M. Conversion to off-pump coronary bypass without increased morbidity or change in practice. Ann Thorac Surge 2002; 73: 798–802.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan

    Michiko Itshida MD, Junjiro Kobayashi MD, Osamu Tagusari MD, Ko Bando MD, Kazuo Niwaya MD, Hiroyuki Nakajima MD, Satsuki Fukushima MD & Soichiro Kitamura MD

Authors
  1. Michiko Itshida MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Junjiro Kobayashi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osamu Tagusari MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ko Bando MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuo Niwaya MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroyuki Nakajima MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Satsuki Fukushima MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Soichiro Kitamura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Itshida, M., Kobayashi, J., Tagusari, O. et al. Comparison of off-pump and on-pump coronary artery bypass grafting in midterm results. Jpn J Thorac Caridovasc Surg 52, 240–246 (2004). https://doi.org/10.1007/s11748-004-0117-9

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-004-0117-9

Key words

Search

Navigation