A randomised comparison of off-pump and on-pump multivessel coronary artery bypass
surgery. Khan N E, De Souza A, Mister R et al. N Engl J Med 2004;
350: 21-28.
Coronary artery bypass grafting performed with cardiopulmonary bypass and cardiac arrest provides a
motionless, bloodless surgical field, allowing optimal conditions for the construction of coronary
anastomoses. The effects of the use of coronary-artery bypass surgery without cardiopulmonary bypass and
cardiac arrest (off-pump) on graft patency remains uncertain. This study was a prospective, randomised,
controlled study to compare graft-patency rates and clinical outcomes in off-pump and conventional on-pump
surgery. Overall, 50 patients were randomised to undergo on-pump coronary artery bypass grafting and 54 to
undergo off-pump surgery. Surgical and anaesthetic techniques were standardised for both groups. Clinical
outcomes and troponin T levels were measured. Three months later patients underwent coronary angiography,
including quantitative analysis. The mean age of the patients was 63 years and 87% were men. The
on-pump group received a mean of 3.4 grafts and the off-pump 3.1 (p=0.41). There were no
deaths. The was no significant difference in the median post-operative length of stay between the two
groups. The area under the curve of the troponin T levels was higher during the first 72 hours in the
on-pump group than the off-pump group. At three months, 127 of 130 grafts were patent in the on-pump group
(98%) as compared with 114 of 130 (88%) in the off-pump group (p=0.002). The patency rate was
higher for all graft territories in the on-pump group than in the off-pump group. It was concluded that
off-pump coronary artery surgery was as safe as on-pump surgery and caused less myocardial damage.
However, the graft patency rate was lower at 3 months in the off-pump group than in the ob-pump group.
This difference may have implications with respect to the long-term outcome.
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