MUNICH — Off-pump coronary artery bypass graft surgery produced shorter surgery times and quicker hospital discharges, but it also resulted in worse long-term patient outcomes, based on results from a randomized study with about 280 patients done at one center in Brazil.
Performing coronary bypass surgery on pump in 144 patients led to about a 5% composite rate of myocardial infarction, death, or need for new intervention during an average follow-up of 3 years, Dr. Neuza Lopes and his associates reported in a poster at the annual congress the European Society of Cardiology. In contrast, off-pump surgery in 142 patients resulted in a combined adverse event rate during 3 years of 13%, a statistically significant difference between the two groups reported Dr. Lopes, a cardiac surgeon at the University of São Paulo, Brazil, and his associates.
The 3-year mortality rate was about 1% in the patients treated on pump, and about 2% in those treated off pump, a difference that was not statistically significant.
The study randomized patients who were suitable for either on- or off-pump surgery. Their average age was about 60, about 80% were men, and about three-quarters had triple-vessel coronary disease; the other 25% had two-vessel disease. Their average left ventricular ejection fraction was about 65%.
Off-pump surgery had many advantages during initial surgery and hospitalization. Average time spent in the ICU was 20 hours for off-pump patients and 38 hours for those with on-pump surgery. Intubation time averaged 6 hours off pump and 10 hours on pump. Total hospital stay averaged almost 6 days off pump and 8 days on pump. Off-pump patients also needed an average of about a third less blood during surgery, and total surgical time was reduced by an average of about 100 minutes. All of these short-term differences were statistically significant.
But off-pump surgery was also associated with one short-term disadvantage: The incidence of atrial fibrillation was 29% in the off-pump patients, compared with a 4% rate in the on-pump patients, a statistically significant difference.