Off-pump vs on-pump redo coronary artery bypass grafting

  • Rufa MI & al.
  • J Thorac Cardiovasc Surg
  • 11 May 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Off-pump redo coronary artery bypass grafting (CABG) was associated with fewer post-operative complications, faster recovery and better long-term survival, demonstrating the safety and efficacy of the procedure.

Why this matters

  • Findings suggest that in the setting of an experienced, high-volume off-pump coronary artery bypass (OPCAB) centre, off-pump revascularisation may be a valid and safe option for patients who require redo CABG.

Study design

  • Propensity score analysis of long-term follow-up of 304 patients (mean age 69.77±8 years) who underwent isolated redo CABG (on-pump redo CABG, n=179; off-pump redo CABG, n=125).
  • Median follow-up rate was 4.01 years.
  • Funding: None disclosed.

Key results

  • Overall rate of completeness of revascularisation was 81.4%, with a higher percentage in favour of off-pump redo CABG group (86% vs 77%; P=.11)
  • Off-pump redo CABG vs on-pump redo CABG was associated with:
    • lower rate of post-operative renal failure requiring dialysis (0% vs 4.6%; P=.06)
    • reduced length of hospital (10.08±5.35 vs 14.1±10.6 days; P=.001) and intensive care unit stay (1.33±1.03 vs 4.4±7.98 days; P<.001>
  • Long-term survival rate was better with off-pump redo CABG (log-rank test, P=.086).

Limitations

  • Residual bias and unconsidered confounding.