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5 Years Results of Off-Pump VS On-Pump CABG Prospective Non-randomized Comparative Study. Piya Cherntanomwong*, Panuwat Lertsithichai*, Somchai Viengteerawat**, Suchart Chaiyaroj*. *Cardiothoracic surgery unit, Department of surgery **Department of Anesthesiology - PowerPoint PPT Presentation
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5 Years Results of 5 Years Results of Off-Pump VS On-Pump Off-Pump VS On-Pump CABGCABG Prospective Non-randomized Comparative Study
Piya Cherntanomwong*, Panuwat Lertsithichai*, Somchai Viengteerawat**, Suchart Chaiyaroj*.
*Cardiothoracic surgery unit, Department of surgery**Department of AnesthesiologyFaculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok,Thailand.
ObjectivesObjectives
To review experience of off pump and on pump CABG at our institute to compare early and long-term results and to determine the differences of OPCAB and conventional CABG.
Prospective, Non-randomized Study (Approved by Ethic Committee, Protocol ID : 06-51-03)
Baseline characteristics were compared
Primary Endpoint
Secondary Endpoint
Follow up to December 2008
The outcomesThe outcomes
Primary endpoints
•Operative mortality
•Bleeding and Blood transfusion
•Myocardial injury•Post operative AF•Other post
operative complications
Secondary endpoints
• Late death•MI • Stroke•PCI•Redo CABG• Sternal wound
infection
Operative technique for Off Pump CABG
Octopus tissue stabilizer
Starfish heart positioner
(Medtronic Inc., Minneapolis, MN)
The intracoronary shunt
Data Analysis
Continuous data were compared between two independent groups using unpaired t-test or Wilcoxon rank sum test as appropriate, and categorical data were compared between groups using the chi-square test.
The long-term probability of survival was estimated using the Kaplan-Meier method. Cox proportional hazards models were used to test the significance of prognostic factors for long-term survival.
All statistical analyses were performed using Stata version 9 (Stata Corp, College Station, TX, USA). Statistical significance was defined as a two-sided p-value of 0.05 or less.
Base-Line Characteristics of the Base-Line Characteristics of the PatientsPatients
Off pump On pump P-value
Number pateints 170 cases 99 cases 71 cases
Sex male 79 ( 80% ) 55 ( 72% ) 0.16 ( NS )
female 20 ( 20% ) 22 ( 28% ) ( NS )
Age 60.873 + 8.46 60.515 + 11.72 0.83 ( NS )
BW 66.474 + 1.046 66.907 + 1.326 0.54 ( NS )
Previous HT 98 ( 100 % ) 77 ( 99%) ( NS )
Previous DM 32 ( 33% ) 36 ( 46%) 0.08 ( NS )
Previous MI 53 ( 55% ) 23 ( 29%) 0.10 ( NS )
Previous CHF 42 ( 43%) 25 ( 32%) 0.13 ( NS )
Previous COPD 83 ( 85%) 52 ( 67%) 0.06 ( NS )
Previous CVA 6 ( 6% ) 9 ( 11%) 0.21 ( NS )
Previous Renal dysfunction 44 ( 46%) 21 ( 27%) 0.15 ( NS )
Previous Renal failure 0 1 (1.4%) ( NS )
Previous Peripheral vascular disease
0 2 (2.8%) ( NS )
Previous AF 5 ( 5%) 3 ( 7%) 0.32 ( NS )
LVEF 42 + 8.8 43 + 12 0.56 ( NS )
Functional class 3 + 1 2.7 + 0.9 0.06 ( NS )
No. Vessel bypass 3.9 + 1.0 3.6 + 0.8 0.07 ( NS )
EuroSCORE (logistic) 4.2% 2.9% 0.05 ( NS )
Off pump On pump P-value
Record ICD mean
12 hr. median/range
145 cc.
100 ( 0 – 1360 ) cc.
201 cc.
140 ( 0 – 1160 ) cc.
< 0.001
PRC mean
median/range
3. u
2 ( 0 – 6 ) u
4. u
2 ( 1 – 13 ) u
0.006
LPPC mean
median/range
1. u
0 ( 0 – 4 ) u
6. u
0 ( 0 – 8 ) u
0.001
FFP mean
median/range
0.5 u
0 ( 0 – 5 ) u
3. u
( 0 – 10 ) u
0.001
Results of using blood transfusion Results of using blood transfusion and bleedingand bleeding
The results of using blood The results of using blood transfusion transfusion (p < 0.05) (p < 0.05)
Average serum CKMB plotted Average serum CKMB plotted against time after operation for on-against time after operation for on-
pump versus off-pump CABGpump versus off-pump CABG
0
20
40
60
80
100
postop
postop 12
postop 36
postop 60
postop 72
on pump
off pump
Complication Off-pump On-pump P-value
Postoperative AF 10 ( 10% ) 19 ( 24% ) 0.013Postoperative Re-operation 1 (1%) 1 (1.4%) NS
Postoperative MI 0 0 NS
Postoperative CVA 1 (1%) 0 NS
Postoperative Renal Failure 0 2 (2.8%) NS
Postoperative Respiratory Failure
0 2 (2.8%) NS
Postoperative Sternum infection 1 (1%) 1 (1.4%) NS
Postoperative Sepsis 0 0 NS
Mortality 1 (1%) 1 (1.4%) NS
Results of Postoperative Results of Postoperative ComplicationsComplications
Results of 5 years Results of 5 years outcomesoutcomes
On pump (n = 71) Off pump (n = 99) p-value
Follow up time (mo)
Mean (SD) 58.2 (15.6) 53.8 (11.0) 0.032
Median (range) 63.7 (13.4 to 73.8) 55.6 (11.5 to 70.1) < 0.001
Cardiac death 0/71 2/99 (2%) 0.511
Noncardiac death 4/71 (6%) 1/99 (1%) 0.162
All death 4/71 (6%) 3/99 (3%) 0.453
MI event 0/71 2/99 (2%) 0.511
PCI event 1/71 1/99
Redo CABG 0/71 0/99
Stroke event 0/71 0/99
Sternal infection 0/71 0/99
5 Years Survival of 5 Years Survival of Off Pump VS On PumpOff Pump VS On Pump
0.00
0.25
0.50
0.75
1.00
Su
rviv
al P
rob
abil
ity
0 20 40 60 80Time since operation (months)
Kaplan-Meier Estimates: On Pump vs. Off Pump
On Pump
Off Pump 96%
95%
170 164 150 65 13
ConclusionConclusion
Our studies have shown that the “Off Pump” CABG in our patient population is associated with lower incidence of post operative AF, lesser myocardial injury, lesser bleeding and blood transfusion with comparable excellent 5 years survival.Off pump may be more benefit than conventional CABG in the patients who has higher risk and poor reserve.
“Dedicated to our Rama-Off Pump Team”