Off-pump and on-pump coronary artery bypass grafting (CABG) are associated with similar long-term outcomes, according to a new meta-analysis of nearly 70,000 patients.
The study, published in the American Journal of Cardiology, included data from 22 different trials completed in the United States, U.K., Canada, Italy, Spain, Brazil, Japan, Taiwan or Germany.[1] Only randomized controlled trials and propensity-matched observational studies were included. Research that only examined short-term outcomes was excluded.
“The debate between off-pump CABG and on-pump CABG has been ongoing for several decades,” wrote first author Maria Comanici, MD, with the department of cardiac surgery at Harefield Hospital in London, and colleagues. “The promotion of off-pump CABG was driven by its potential advantages over some of the drawbacks associated with traditional on-pump CABG. These benefits include avoiding the use of cardiopulmonary bypass (CPB) and minimizing manipulation of the aorta. Proponents of off-pump CABG anticipated reductions in early mortality, perioperative neurological events, renal failure, blood product transfusions, and the length of hospital stays. In contrast, critics of off-pump CABG have expressed concerns about the possibility of incomplete or lower-quality coronary revascularization, which could potentially lead to an increased need for repeat revascularization procedures and late mortality.”
The study was split evenly, with approximately 50% of patients undergoing treatment with each CABG technique. Also, even though off-pump CABG remains a more “technically demanding” treatment option, it was not associated with a significant difference in the number of grafts per patient.
Overall, the authors found that all-cause mortality after 10 years was similar for these two bypass surgery techniques.
“The findings challenge previous perceptions and suggest that, in well-selected patients and when performed by experienced surgeons, off-pump CABG can offer comparable long-term outcomes to on-pump CABG,” the authors wrote. “However, it is essential to acknowledge the technical complexity of off-pump CABG and the need for surgical expertise, emphasizing the importance of surgeon proficiency in determining the success of the procedure.”
The group also noted that that the complex nature of cardiac surgical revascularization suggests it should be seen as its own subspecialty within cardiac care.
“Specialized training and expertise in revascularization procedures could foster innovation, improve outcomes, and enhance patient safety,” they wrote. “Moreover, the emphasis should not solely be on the technical aspects but also on patient selection, perioperative care, and long-term follow-up. A dedicated subspecialty approach could facilitate tailored interventions and foster collaborative research endeavors, ultimately benefiting patients with multivessel coronary artery disease.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.