Objectives: The Arterial Revascularization Trial (ART) is a randomized comparison of bilateral internal mammary artery (BIMA) versus single internal mammary artery (SIMA) grafting in coronary artery bypass graft (CABG) surgery and is one of the largest randomized trials of surgery ever conducted. ART is also one of the largest studies of contemporary CABG with a high proportion of off-pump surgeries (41%). The objective of this post hoc analysis was to evaluate the surgical process and 1-year outcomes for surgery performed on-pump compared with off-pump.
Methods: ART randomized 3102 patients with multivessel coronary artery disease (CAD) to SIMA or BIMA grafts to determine if BIMA grafts have an additional survival advantage at 10 years. The 1-year interim analysis showed an overall very low mortality and major morbidity rate irrespective of whether the procedure was with an SIMA or BIMA. The surgical process and 1-year outcomes were analysed according to whether surgery was performed on-pump or off-pump.
Results: Baseline variables were not statistically significantly different between on- and off-pump surgery within each treatment group after taking account of the effects of clustering by individual surgeons. At both 30 days and 1 year, there was a low incidence of death (1.2%, 2.3%), stroke (1.1%, 1.7%), myocardial infarction (MI) (1.4%, 1.9%), repeat revascularization (0.5%, 1.5%) and wound reconstruction (1.2%). A similar average number of grafts were performed with on- and off-pump surgery (median = 3), but the duration of surgery was 20-30 min and ventilation time ∼ 2 h shorter with off-pump surgery. Blood loss and platelet transfusions were lower in the off-pump group, with no difference in the need for balloon pump or renal support. Sternal wound reconstruction was similar with off-pump surgery in the SIMA group (0.5 vs 0.6%) and lower with off-pump surgery in the BIMA group (1.4 vs 2.2%). Repeat revascularization was marginally higher in off-pump patients at 30 days (0.8 vs 0.3%) and at 1 year (1.7 vs 1.3%).
Conclusions: The outcomes of contemporary CABG are excellent with low mortality, stroke, myocardial infarction and need for wound reconstruction and repeat revascularization whether performed on-pump or off-pump.
Clinical Trial Registration: Controlled-trials.com (ISRCTN46552265).
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1093/ejcts/ezu349 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Impact of vasopressin use for postoperative atrial fibrillation in off-pump coronary artery bypass grafting.
Nagoya J Med Sci
November 2024
Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Postoperative atrial fibrillation complicates 15-40% of cardiac surgery cases and is associated with various adverse health outcomes including high mortality. Although vasopressin administration decreases postoperative atrial fibrillation in on-pump coronary artery bypass grafting, its use in off-pump coronary artery bypass grafting has not been investigated. Therefore, we evaluated the effect of vasopressin use in off-pump coronary artery bypass grafting.
View Article and Find Full Text PDFHeparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective study.
J Cardiothorac Surg
January 2025
Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Road, Xicheng District, China.
Background: Heparin, an anticoagulant used in cardiac surgery, can result in heparin rebound (HR), where it returns postoperatively despite being neutralized with protamine. This study was designed to investigate the prevalence of HR in patients undergoing off-pump coronary artery bypass grafting (OPCAB) and evaluate the impact of HR on their short-term outcomes.
Methods: HR was defined by a 10% increase in activated coagulation time (ACT) following two hours of heparin neutralization with protamine, bleeding over 200 mL/h, and abnormal laboratory coagulation examination results.
A Rare Case of Early Left Ventricular Thrombus Development After Off-Pump Coronary Artery Bypass Grafting for Unstable Angina Pectoris With Reduced Left Ventricular Ejection Fraction.
Cureus
December 2024
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, JPN.
Left ventricular (LV) thrombus is a serious complication of myocardial infarction (MI) that can lead to a fetal systemic embolism. Although coronary artery bypass graft surgery (CABG) after MI is widely performed, to our knowledge, there are no reports of LV thrombus in the early postoperative period. Here, we report a rare case of a 70-year-old man who underwent off-pump coronary artery bypass grafting (OPCAB) for unstable angina pectoris with reduced left ventricular ejection fraction (LVEF).
View Article and Find Full Text PDFThe Effects of Seasonal Variation on the Outcomes of Patients Undergoing Off-Pump Coronary Artery Bypass Grafting.
Rev Cardiovasc Med
December 2024
Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, 100037 Beijing, China.
Background: The impact of seasonal patterns on the mortality and morbidity of surgical patients with cardiovascular diseases has gained increasing attention in recent years. However, whether this seasonal variation extends to cardiovascular surgery outcomes remains unknown. This study sought to evaluate the effects of seasonal variation on the short-term outcomes of patients undergoing off-pump coronary artery bypass grafting (OPCABG).
View Article and Find Full Text PDFArticle Synopsis
- This study examines the role of serum uric acid (SUA) levels in patients undergoing off-pump coronary artery bypass (OCABG) surgery, focusing on their impact on postoperative complications like acute kidney injury (AKI).
- The research involved 144 patients and found that 20% experienced AKI, with higher preoperative SUA levels significantly linked to increased risk (OR: 2.04).
- Additionally, elevated SUA levels correlated with longer hospital stays and a higher mortality rate (up to 13% in high SUA patients), indicating that SUA is a crucial predictor for postoperative outcomes.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!