Outcomes Between On-Pump and Off-Pump Procedures of Heart Bypass Surgery Not Much Different, Finds 10-Year Study

A study that analyzed patient outcomes in coronary artery bypass grafting (CABG) in veterans showed outcomes for on-pump and off-pump procedures over 10 years to be similar.

The new study by researchers at Stony Brook University (Stony Brook, NY, USA) monitored patients who received “on-pump” or “off-pump” coronary artery bypass grafting (CABG) over a 10-year period and revealed that outcomes between the two forms of heart bypass surgery are not much different. For the past 20 years surgeons have debated whether traditional on-pump surgery, which uses a heart-lung machine to circulate the blood while the heart is stopped enabling surgeons to more easily complete CABG; or off-pump, which eliminates complications potentially caused by the heart lung machine yet makes the procedure more technically difficult. Monitoring the post-CABG outcomes of all original ROOBY trial patients, this phase IV clinical trial represents the largest US-based, multicenter, randomized clinical trial comparing off-pump versus on-pump patients.

The researchers tracked more than 1,000 veterans for each group - those treated by way of on-pump and those with off-pump procedures over 10 years. The average age at the time of surgery for both groups was about 63. According to the researchers, no significant 10-year treatment-related differences were documented for any primary or secondary post-CABG endpoint rates. Endpoints included repeat CABG, other heart revascularization procedures, and changes in cardiac symptoms. The death rates at 10 years were 34.2% for the off-pump group and 31.1% for the on-pump group.

Although the 10-year outcome rates were not different, the researchers did, however, document a slightly shorter revascularization-free survival period among patients in the off-pump group. Additionally, the median time to death in the off-pump patients was 5.6 years, and the median time to death in the on-pump patients was 6.1 years. Across all study outcomes, moreover, no off-pump advantages were found.

“While our findings may not settle the ongoing debate about on-pump versus off-pump advantages with CABG, the data is strong to support the notion that for patients who are viable candidates for either procedure, no benefits were found for using an off-pump procedure,” said Laurie Shroyer, PhD, Professor of Surgery in the Renaissance School of Medicine at Stony Brook University, who led the study. “As these veterans were nearly all men, the findings should not be generalized to women or non-veterans. Thus, surgeons should choose the best CABG method based each individual patient’s risks and in light of the surgeon’s own technical CABG expertise and post-CABG outcome experiences. In summary, each CABG patient’s care should be customized to meet their unique needs.”

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