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Background:
Randomized On/Off Bypass (ROOBY) trial was a controlled, single blind, randomized trial conducted at 18 VA medical centers between February 2002 to May 2008 which reported no significant difference in the rate of 30-day composite outcome of death or complications between off-pump (OPCAB) and on-pump CABG but worse outcomes at 1 year in OPCAB patients.
Methods:
Between October 2007 and September 2010, 102 consecutive patients requiring isolated CABG underwent OPCAB revascularization without any exclusions by a single surgeon (L.L.) at VA Hospital in Madison ,WI (VAHM). Thirty day composite outcomes of death or complications (reoperation, new mechanical support, cardiac arrest, coma, stroke, or renal failure) were obtained from the NSQIP database and compared with those of patients undergoing OPCAB as part of the ROOBY trial.
Results:
Preoperative 30 day mortality estimates were similar in both groups (1.8±1.8 vs 1.9±1.8, p=0.592). Compared to ROOBY trial patients, those who underwent OPCAB at VAHM were older (65.1±8.4 vs 63.0±8.5, p=0.020), had lower conversion rate to on-pump CABG (1% vs 12.4%, p<0.001), shorter shorter postoperative stay in ICU (2.7±1.6 vs. 3.7±3.8 days, p=0.009), shorter total hours on ventilator (8.2±11.6 vs. 17.1±36.5, p=0.014). There were no significant differences in number of grafts (3.0±1.0 vs. 2.9±0.9, p=0.394) and postoperative length of stay (6.9±3.6 days vs. 8.2±8.8 days, p=0.139). Thirty day composite outcome of death or complication was higher in OPCAB patients enrolled in ROOBY trial (7.0% vs 2.0%, p=0.002).
Conclusions:
Patients who underwent OPCAB as part of the ROOBY trial had high rate of early complications compared to our series of consecutive patients offered OPCAB as first intention to treat. The less favorable early results in ROOBY trial may have influenced their 1 year outcomes.