Effects of on- and off-pump coronary artery surgery on graft patency, survival and quality of life: long term follow-up of two randomised controlled trials
Gianni D. Angelini, Lucy Culliford, David Smith, Mark Hamilton, Gavin Murphy, Raimondo Ascione, Andreas Baumbach, Barney Reeves; Bristol Heart Institute, Bristol, United Kingdom
Comment on this Abstract
Objective: Patients have less post-operative morbidity and shorter ICU and hospital stays with off-pump (OPCAB) than on-pump coronary artery bypass grafting (CABG-CPB). However, only about 15%-20% of coronary bypass operations worldwide are carried out using OPCAB. Surgeons may be reluctant to use OPCAB due to concerns about graft patency.
The aim of this study was to assess long-term patency rate and health outcomes of patients enrolled in the BHACAS 1&2 trials
Methods: Participants in two randomised trials comparing OPCAB and CABG were followed for 6-8 years after surgery to assess graft patency, major adverse cardiac-related events (MACE) and health-related quality of life (HRQoL). Patency was assessed by multidetector computed tomography coronary angiography (MDCTA) with a 16-slice scanner. Two blinded observers classified proximal, body and distal segments of each graft as occluded or not. MACE and HRQoL were obtained from questionnaires to participants and family practitioners.
Results: Fifty-two (13.0%) of 401 randomised participants had died; of the remaining 349, 298 (85%) completed HRQoL questionnaires and 199 (57%) had MDCTA scans. There was no evidence of attrition bias for any outcome. Patency was studied in 505 grafts. Mean duration of follow-up from operation to MDCTA was 85.1 months (SD 4.8) and 85.8 months (SD 4.7) for CABG-CPB and OPCAB groups. Overall, 439/492 (89.2%) of grafts were patent. Percentages of grafts classified as patent were similar in CABG-CPB and OPCAB groups, both overall (228/255, 89.4% and 211/237, 89.0%; odds ratio=1.00, 95% CI 0.55-1.82, p>0.99) and for arterial and vein grafts separately. Vein grafts were less likely to be patent (218/250, 87.2%) than arterial grafts (221/242, 91.3%). Graft occlusion was more likely at the distal than the proximal anastomosis (odds ratio=1.11, 1.02-1.20). There were also no differences between OPCAB and CABG-CPB groups in: the hazard of death (hazard ratio=1.24, 0.72-2.15), or MACE or death (hazard ratio=0.84, 0.58-1.24); mean HRQoL across a range of domains and instruments.
Conclusion: : Long term graft patency and other health outcomes are similar with OPCAB to those with CABG-CPB when both operations are performed by experienced surgeons.
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