Early and Mid-term Outcomes of Off-pump Versus On-pump Coronary Artery Bypass Surgery in Patients With Triple-Vessel Coronary Artery Disease: A Randomized Controlled Trial

Abstract

Abstract background and aim of the study: Several studies have compared early and mid-term outcomes of on-pump coronary artery bypass grafting (CABG) and off-pump CABG. However, there is still an ongoing debate on this matter, especially in patients with triple-vessel coronary artery disease (3VD). Methods: We randomly assigned 274 consecutive patients with 3VD to two equal groups to undergo on-pump CABG or off-pump CABG. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, acute coronary syndrome, stroke or transient ischemic attack, and the need for repeat revascularization. The secondary outcomes were postoperative infection, ventilation time, duration of ICU admission, length of hospital stay, and renal failure after surgery. Results: The mean follow-up duration was 31.1 ± 5.9 months. The mean age of patients was 61.4±9.3 years (range: 38 to 86), and 207 (78.7%) were men. There were 15 (11.2%) and 9 (7.0%) MACCE occurrence in on-pump and off-pump groups, respectively (P-value =0.23). None of the MACCE components, including CVA, non-fatal MI, and revascularization, did not significantly differ between on-pump and off-pump groups. We observed no difference in the occurrence of MACCE between off-pump and on-pump groups in multivariate regression analysis (HR=0.57; 95% CI: 0.24–1.32; P-value=0.192). There were no statistical differences in postoperative outcomes between the off-pump and on-pump CABG groups. Conclusions: We found no significant differences between on-pump and off-pump CABG in the rate of MACCE and postoperative complications incidence when surgery is performed in the same setting by the same surgeon. (IRCT20190120042428N1)