The relative benefits and risks of off-pump coronary artery bypass grafting (CABG) as compared with the use of CBP are not clearly defined. The CORONARY trial in 79 centers randomized 4,752 patients in whom CABG was planned with or without CBP. There was no significant difference in the primary end point which was a composite of death, MI, stroke or new renal failure requiring dialysis at thirty days after randomization.
The study showed no significant difference in the rate of the primary endpoint between the groups with or without CBP, (9.8% versus 10.3%, p = 0.59), or any of its individual components. Off- pump significantly reduced transfusion requirements, (50.7% versus 63.3%, relative risk 0.80, 95% CI, 0.75 to 0, 85, P <0.001), reoperation for intraoperative bleeding, (1.4% versus 2.4%, relative risk 0.61, 95% CI, 0.40 to 0.93, P = 0.02), acute kidney injury, (28.0% versus 32.1%, relative risk 0 , 87, 95% CI, 0.80 to 0.96, p = 0.01), and respiratory complications, (5.9% versus 7.5%, relative risk 0.79, 95% CI, 0.63 – 98, P = 0 , 03), but increased the initial rate of revascularization, (0.7% versus 0.2%, relative risk, 4.01, 95% CI, 1.34 to 12.0, p = 0.01). There were no significant differences in the rate of death, myocardial infarction, stroke or renal failure requiring dialysis after thirty days.
Comments: Off- pump surgery technique is the most used in the United States and is the easiest to perform according to Dr. Lamy. Despite some favorable outcomes for off-pump surgery, the results of evolution to one year failed to confirm this benefit. Patients under EuroSCORE are not candidates for CBP and high-risk patients seem to benefit more from surgery with CBP according to Dr. Lamy.
Andre Lamy
2013-03-11
Original title: CORONARY: The Coronary Artery Bypass Grafting Surgery Off or On Pump Revascularization Study. Results at 1 year.
