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Five-Year Outcomes After On-Pump and Off-Pump Coronary-Artery Bypass

Thursday, August 17, 2017

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Source Name: New England Journal of Medicine


A. Laurie Shroyer, Brack Hattler, Todd H. Wagner, Joseph F. Collins, Janet H. Baltz, Jacquelyn A. Quin, G. Hossein Almassi, Elizabeth Kozora, Faisal Bakaeen, Joseph C. Cleveland, Jr., Muath Bishawi, and Frederick L. Grover, for the Veterans Affairs ROOBY-FS Group

The 5-year outcomes of a Veterans Affairs trial of off-pump vs on-pump CABG are reported.  Mortality in the off-pump group was 15.2% compared to 11.9% in the on-pump group (RR 1.28; p=0.02).  Composite adverse events were more common in the off-pump group (31.0% vs 27.1%; RR 1.14; p=0.046).  Repeat CABG was more common for the off-pump group (1.4% vs 0.5%; p=0.02).  No differences were observed in nonfatal MI, death from cardiac causes, or repeat revascularization.


Unfortunately, the expected outcome has occurred. Poor initial surgery translates into poor longer term outcomes. The quality of OPCABG surgery in the initial study was poor, with a 6-fold rate of conversion compared to the national average in the US. This new analysis adds nothing, save to confirm the original study was a well designed and executed investigation undertaken by surgeons who should not be performing off-pump surgery.

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