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Long-term follow-up of off-pump and on-pump coronary artery bypass grafting
Shahzad G. Raja, MRCS, FRCS(C-Th)1, Dimple Chudasama2, Siobhan Daley2, Mubassher Husain3, Mohamed Amrani3.
1Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom, 2Department of Quality & Safety, Harefield Hospital, London, United Kingdom, 3Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
OBJECTIVE: Despite increasing recognition of the benefits of off-pump coronary artery bypass grafting concerns persist regarding its impact on long-term mortality and freedom from re-intervention. In this study we assessed the impact of off-pump coronary artery bypass grafting on long-term outcomes.
METHODS: From January 2002 to December 2002, 307 consecutive patients that underwent isolated multi-vessel off-pump coronary artery bypass grafting at our institution were compared to a control group of 397 patients that underwent multi-vessel on-pump coronary artery bypass grafting during the same period. Peri-operative data was prospectively collected and compared. In-addition, univariate and risk-adjusted comparisons between the two groups were performed at 10 years.
RESULTS: After adjusting for clinical covariates, off-pump coronary artery bypass grafting did not emerge as a significant independent predictor of long-term mortality (Hazard Ratio 0.91; 95% Confidence Interval 0.70-1.12), readmission to hospital for cardiac cause (Hazard Ratio 0.96; 95% Confidence Interval 0.78-1.10) or the need for re-intervention (Hazard Ratio 0.93; 95% Confidence Interval 0.87-1.05).
CONCLUSIONS: At long-term follow-up, off-pump coronary artery bypass grafting remains a safe and effective myocardial revascularization strategy with no adverse impact on survival or freedom from re-intervention.
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