WHETHER OFF OR ON-PUMP, ARTERIES ARE NOT IN VAIN: MID-TERM FOLLOW-UP OF TOTAL ARTERIAL OFF VS ON-PUMP SURGERY IN 899 CONSECUTIVE "ALL-COMER" PATIENTS
Teresa M. Kieser, M. Sarah Rose, Mouhieddin Traboulsi, Kishan narine.
University of Calgary, Calgary, AB, Canada.
OBJECTIVE: Off-pump coronary artery bypass graft (CABG) surgery benefits higher risk patients early. Arterial grafting benefits patients long-term. We sought to compare mid-term (up to 3 years) outcomes in total arterial CABG patients undergoing off and on-pump surgery.
METHODS: Outcomes were compared between off and on-pump patients in a prospective cohort of all consecutive CABG patients from July 2003- September 2011 using Kaplan-Meier survival curves and Cox regression.
RESULTS: A cohort of 899 consecutive CABG patients received 98% arterial grafts, 72% BIMA and 37% of these CABG procedures were performed off-pump. On-pump was the principal procedure of choice for the first 529 patients (6% of patients in this group went off-pump for single vessel disease or prohibitive ascending aortic calcification).Thereafter off-pump was performed in 78% of CABG procedures. Demographics for the whole group included: mean age 65+/-10.4, diabetes mellitus in 33%, males 78%, urgent-in patients 46%, emergent 11%, and mean logistic EuroSCORE for all patients was 5.88. Total operative mortality was 3.4%/4.3% (p=0.605) for off-pump vs. on-pump patients. Thirty-four out-of-province patients were unavailable for follow-up, leaving 828 patients with a median follow-up of 4.8 years (IQR 2.6, 7.0). At three years post-surgery, after controlling for EuroSCORE at time of surgery, there was no significant difference between on-pump and off-pump patients for overall survival (HR=1.39, p=0.274), post-operative angioplasty (HR=0.96 p=0.948), and new angina (HR=0.94 p=0.870). At 3 years post-surgery overall survival (95% CI) was 92.8%(87.4,96.0) for off-pump and 95.5%(93.2,97.0) for on-pump patients, rates of post-operative angioplasty were 1.8%(0.76,4.36) for off-pump and 1.8%(0.93,2.9) for on-pump patients, angina occurred in 4.1%(2.2,7.6) of off-pump and 3.2%(1.9,5.1) of on-pump patients. Transit-time flow for assessment of intra-operative graft function was used equally in both off and on-pump groups since April 2004 (86% of all CABG patients).
CONCLUSIONS: At 3 years post-operatively, both off and on -pump patients with 98% arterial grafts have similar survival, development of angina and need for angioplasty. Arterial grafting can benefit even those in whom off-pump is mandated.
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