Off pump coronary artery bypass

Compared to standard bypass grafting associated with similar mortality but shorter hospital stay and fewer transfusions.

Decreased release of cardiac enzymes and decreased atrial fibrillation compared to conventional surgery.

In a random assignment of 2203 patients scheduled for urgent or elective coronary artery bypass graft take either on pump, water pump procedures: no significant difference existed between off-pump and on-pump coronary artery bypass graft in the rate of 30 day composite outcomes of death or complications before discharge or within 30 days after surgery (Shroyer AL).

At one year of follow-up in the above study the off-pump group had worse composite outcomes and poorer graft patency than the patients in the on-pump group (Randomized on/off Bypass-ROOBY).

In the study, comparing off-pump to on-pump coronary artery bypass grafts no differences were found in the neuropsychological outcomes oruse of major resources (ROOBY trial).

In the ROOBY trial there was a tendency to have less complete revascularization with off pump techniques with mean 2.9 grafts per patient completed as compared with on pump coronary artery bypass graft with a mean of 3.0 grafts per patient.

In the ROOBY trial rate of patency of left internal thoracic artery grafts was about 95% in both on-pump and off-pump groups, and a one-year patency rate for saphenous-being graphs was 80%, although the on-pump group patency rate was 83.8% vs. 76.6% in the off-pump group.

In the ROOBY trial there was no cognitive decline within one year after surgery in either the on or off pump groups.

In the CABG Off or On Pump Revascularization Study (CORONARY) randomly assigned to on-pump or off-pump surgery among 752 patients: no difference in 30 day rate of death, myocardial infarction, stroke or renal failure (Lamy A et al). LM In a randomized study of 4752 patients assigned to undergo off pump or on pump coronary artery bypass graft: No significant difference appeared between off pump and on pump CABG with respect to primary outcome, the is rate of repeat coronary revascularization, quality off life, or neurocognitive function at 5 years (Lamy A et al, CORONARY Investigators).

GOPCABE Study Group randomized 2539 patients 75 years of age or older to CABG off or on pump: There was no significant efforts between the patient groups with regard to the composite outcome of death, stroke, myocardial infarction, repeat revascularization, or new renal replacement therapy within 30 days and within 12 months after surgery (Diegeler A et al).

In the above study off-pump had reduced rates of transfusion, reoperation for perioperative bleeding, respiratory complications , acute kidney injury, but increased risk of early revascularization.

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