Early outcome after off-pump versus on-pump coronary bypass surgery - Results from a randomized study

Background-The use of cardiopulmonary bypass during coronary artery bypass surgery (CABG) has been associated with substantial morbidity. The recent i ntroduction of cardiac stabilizers facilitates CABG without cardiopulmonary bypass (off-pump CABG), but it is unknown whether cardiac outcome after of f-pump surgery is similar to that for the on-pump procedure. Methods and Results-In a multicenter trial, 281 patients (mean age 61 years , SD 9 years) were randomly assigned to off-pump or on-pump CABG. In-hospit al results and cardiac outcome and quality of life after I month are presen ted. Cardiac outcome was defined as survival free of stroke, myocardial inf arction, and coronary reintervention. The mean numbers of distal anastomose s per patient were 2.4 (SD 1.0) and 2.6 (SD 1.1) in the off-pump and on-pum p groups, respectively. Completeness of revascularization was similar in bo th groups. Blood products were needed during 3% of the off-pump procedures and 13% of the on-pump procedures (P <0.01). Release of creatine kinase mus cle-brain isoenzyme was 41% less in the off-pump group (P <0.01). Otherwise , no differences in complications were found postoperatively. Off-pump pati ents were discharged I day earlier. At I month, operative mortality was zer o in both groups, and quality of life had improved similarly. In both group s, 4% of the patients had recurrent angina. The proportions of patients sur viving free of cardiovascular events were 93.0% in the off-pump group and 9 4.2% in the on-pump group (P=0.66). Conclusions-In selected patients, off-pump CABG is safe and yields a short- term cardiac outcome comparable to that of on-pump CABG.