Objectives The aim of this study was to compare 5-year rates of overall death, cardiac related death, myocardial infarction, repeat revascularization, stroke, and new occurrence of postoperative renal failure in a large cohort of patients with coronary disease, treated with on-pump or off-pump CABG. Methods Two propensity score (PS) matched cohorts, each of 560 patients, undergoing isolated surgical coronary revascularization at the regional public and private centers of Emilia-Romagna region (Italy) over the period January 1st 2003 – December 31th 2013, were used to compare long-term outcomes of on-pump CABG (6.711 patients) and off-pump CABG (597 patients). Results The matched on-pump group received significantly more bypass grafts than the matched off-pump group (2.4 ±1.1 vs 1.6 ±0.9, p<0.0001). The on-pump group reported statistically significant lower cardiac-related mortality. There was a trend towards higher overall mortality, and need for repeat revascularization procedures in the off-pump group. No difference was found for myocardial infarction, stroke, or new occurrence of postoperative renal failure between groups in the follow-up. Multivariate analysis of significant predictors of mortality in the overall population confirmed that the off-pump revascularization strategy was an independent predictor of death at long-term follow-up. On-pump CABG reported significant better results in terms of mortality in the subgroups of patients with a depressed LVEF and in patients with 3-vessel disease. Conclusions In patients undergoing elective isolated CABG, on-pump strategy conferred a long-term survival advantage compared with off-pump strategy, particularly for patients with more extensive coronary disease. No benefits were found in terms of reduction of postoperative morbidity with the off-pump strategy. On-pump surgery should be the preferred revascularization technique, and off-pump surgery reserved for patients for whom the perioperative risk of
Comparison between off-pump and on-pump coronary artery bypass grafting. Long-term results of a real-world registry / Nicolini, Francesco; Fortuna, D; Contini, Ga; Pacini, D; Gabbieri, D; Zussa, C; De Palma, R; Vezzani, A; Gherli, Tiziano. - In: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY. - ISSN 1010-7940. - 50:(2016), pp. 528-535. [10.1093/ejcts/ezw128]
Comparison between off-pump and on-pump coronary artery bypass grafting. Long-term results of a real-world registry.
NICOLINI, Francesco;GHERLI, Tiziano
2016-01-01
Abstract
Objectives The aim of this study was to compare 5-year rates of overall death, cardiac related death, myocardial infarction, repeat revascularization, stroke, and new occurrence of postoperative renal failure in a large cohort of patients with coronary disease, treated with on-pump or off-pump CABG. Methods Two propensity score (PS) matched cohorts, each of 560 patients, undergoing isolated surgical coronary revascularization at the regional public and private centers of Emilia-Romagna region (Italy) over the period January 1st 2003 – December 31th 2013, were used to compare long-term outcomes of on-pump CABG (6.711 patients) and off-pump CABG (597 patients). Results The matched on-pump group received significantly more bypass grafts than the matched off-pump group (2.4 ±1.1 vs 1.6 ±0.9, p<0.0001). The on-pump group reported statistically significant lower cardiac-related mortality. There was a trend towards higher overall mortality, and need for repeat revascularization procedures in the off-pump group. No difference was found for myocardial infarction, stroke, or new occurrence of postoperative renal failure between groups in the follow-up. Multivariate analysis of significant predictors of mortality in the overall population confirmed that the off-pump revascularization strategy was an independent predictor of death at long-term follow-up. On-pump CABG reported significant better results in terms of mortality in the subgroups of patients with a depressed LVEF and in patients with 3-vessel disease. Conclusions In patients undergoing elective isolated CABG, on-pump strategy conferred a long-term survival advantage compared with off-pump strategy, particularly for patients with more extensive coronary disease. No benefits were found in terms of reduction of postoperative morbidity with the off-pump strategy. On-pump surgery should be the preferred revascularization technique, and off-pump surgery reserved for patients for whom the perioperative risk ofI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
