Coronary artery bypass grafting (CABG) without a cardiopulmonary bypass, (CBP), has increasingly become an alternative to the conventional standard (with pump). However, it is still controversial whether there is a decrease in morbidity and mortality between these two techniques. The aim of this study was to compare these two techniques in a high risk population.
A prospective study where 206 patients were randomized with a EuroSCORE of less than 6 to in-pump CABG, (n = 108), and without CPB, (n = 98). There were no significant differences in clinical characteristics and procedure between the groups. The average age was 74 years with a logistic mean EuroSCORE of 7.66 in the CPB group and 7.69 in the off-pump group. The primary endpoint, (a composite of death, AMI, stroke, acute renal failure requiring dialysis), at thirty days was 20.6% with pump and 9.2% in the off-pump group, (p = 0.028, RR 0,41 [0.19 to 0.91]). The pump group also required more transfusions, (80.2% versus 64.9%).
Conclusion: In patients with a high surgical risk, CBP surgery is a safer way of direct revascularization due to the lower incidence of primary endpoints and a lower rate of transfusions.
Comments: This study, unlike the study results presented in the GOPCABE trial just minutes earlier, shows that patients with a high surgical risk benefit from the less invasive technique. These contradictory results lead us to conclude that the results should be interpreted with caution, reinforcing the importance of standardization, an improvement of the technique and the proper selection of patients.
jan_hlavicka_acc2013
Jan Hlavicka
2013-03-11
Original title: PRAGUE-6 Trial: Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery in Patients with EuroSCORE ≥6.
