Background: There is much debate about a possible benefit of coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) compared with on-pump surgery. However, a randomized study could not confirm this benefit. The objective of these studies was to compare the MACCE, (death, MI, stroke, revascularization repeated and a new dialysis), of surgical revascularization with and without cardiopulmonary bypass (CBP) in patients over 75 years.
Methods and results: A multicenter study randomized 2,539 patients over 75 years of age to CABG with CBP and without CPB. At thirty days after surgery, there was no significant difference between patients who underwent off-pump surgery and those who underwent on-pump surgery in terms of the composite outcome, (7.8% versus 8.2%, odds ratio, 0.95, confidence interval 95% CI, 0.71 to 1.28, P = 0.74), or when analyzed separately for the four components, (death, stroke, myocardial infarction or new dialysis). Revascularization was more frequent after CABG with CPB, (1.3% versus 0.4%, odds ratio 2.42, 95% CI, 1.03 to 5.72, P = 0.04). At twelve months, there were no significant differences between groups in the composite outcome, (13.1% versus 14.0%, odds ratio 0.93, 95% CI, 0.76 to 1.16, P = 0, 48), or any of the individual components.
Conclusion: The GOBCABE randomized study showed no significant difference between revascularization with or without cardiopulmonary bypass (CBP) at thirty days and one year.
Comments: This study showed no differences between CABG surgery with or without CBP in a high-risk population (elderly) and, therefore, more exposed to pump complications. Cognitive status and quality of life after surgery was not assessed which is a limitation. There are many confusing variables that can occur even with the surgeon’s experience with this technique.
anno_diegeler_acc2013_articulo
Anno Diegeler
2013-03-11
Original title: The German Off-Pump Coronary Artery Bypass Grafting in Elderly Patients (GOPCABE) Study. // Presentador:
