Off-Pump vs Conventional Coronary Artery Bypass Grafting: Early and 1-Year Graft Patency, Cost, and Quality-of-Life Outcomes

Abstract

Motivated by morbidity attributable to cardiopulmonary bypass,^1-3 US surgeons performed approximately 21% of coronary artery bypass operations off-pump in 2002.⁴ Nonetheless, concern remains about the technical difficulty of off-pump coronary artery bypass (OPCAB), including the possibility of imprecise anastomoses and incomplete revascularization compromising patient outcomes.^5-9 Two prospective, randomized studies^10,11 and all but a few¹² retrospective comparisons have reported significantly fewer grafts in OPCAB. Retrospective studies among selected patients showing significant benefits of OPCAB over conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass for mortality,^13,14 morbidity,^12-15 length of stay, and cost¹⁵ have been criticized for potential bias in patient selection and management.^5-8 Previous randomized studies among selected low-risk patients^11,16-18 have reported similar results, but cannot be extrapolated to the general population of CABG patients. The potential clinical and economic advantages of OPCAB in unselected patients and the graft patencies that may be achievable are unknown.