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Off-Pump Versus On-Pump Bypass Surgery for Left Main Coronary Artery Disease
The authors in this study performed a post-hoc analysis of the coronary artery bypass grafting (CABG) cohort in the multicenter randomized EXCEL trial, comparing patients undergoing on-pump versus off-pump procedures for left main disease. Of note, in both groups some of the most experienced CABG surgeons in the world participated. The 3-year outcomes of the two CABG groups were compared using inverse-probability-of-treatment weighting for treatment effect estimation. For the 923 CABG patients, 71% and 29% underwent on-pump versus off-pump CABG, respectively.
Outcomes: Off-pump CABG was associated with a lower rate of revascularization of both the circumflex and right coronary artery territories in patients with obstruction of those territories. Moreover, the 3-year all-cause death was roughly double for the off-pump group as compared to the on-pump group (8.8% versus 4.5%, p = 0.02).