All hands to the pumps! Is it all doom and gloom for off-pump coronary surgery?

Edward J. Caruana, Sendhil K. Balasubramanian, Selveraj Shanmuganathan, Suren Naik, Adam Szafranek

Nottingham University Hospitals, Nottingham, United Kingdom

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objectives

The Randomized On/Off Bypass (ROOBY) Trial recently reported higher all-cause mortality at 5 years with off-pump coronary artery bypass grafting (OPCAG). Both off- and on-pump coronary artery bypass grafting (CABG) have been offered at our institution since 1996. We sought to evaluate the real-world long-term outcomes following OPCAG, in our cohort.

Methods

Data obtained from prospective databases for all adult patients undergoing isolated CABG at a single UK centre, between January 2003 and December 2011, was retrospectively analysed. Mortality data was acquired from NHS Spine (median follow-up 10.2 years). Student t-test, Pearson’s Chi-squared, and Logistic Regression analyses were performed using the Analyse-it ® package for Microsoft Excel.

Results

3400 patients - 1122 (33%) OPCAG - were included. A median of 101 (range 31 to 242) OPCAG procedures were performed annually. Patients in the OPCAG group were older (p = 0.01) and had a higher logistic EuroSCORE (p < 0.001, mean difference (MD) 0.9%). Post-operative hospital stay was shorter in the OPCAG group (p = 0.002, MD 1.1 days). There was no difference in all-cause mortality at 30-days (p = 0.52), 5-years (p = 0.54) or 10-years (p = 0.75). There was no discernible impact of institution (p = 0.84) or consultant (p = 0.66) learning curve in OPCAG.

Conclusions

OPCAG is a safe alternative to traditional on-pump CABG, and may be of benefit in higher-risk patients. It should remain a part of the cardiac surgeon’s armamentarium.