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Off-Pump Surgery Appears Equivalent to On-Pump Surgery, But Operative Mortality and Morbidity Are Reduced: Present at STS

By Ed Susman

ORLANDO, FL -- January 31, 2008 -- Surgeons adept at performing coronary artery bypass graft (CABG) surgery without putting a patient on the heart-lung machine suggest their "off-pump" procedure gives a patient benefits in mortality and morbidity.

In a study that included patients for the 10-year period ending in 2007, the surgeons reviewed data on 12, 812 consecutive patients who underwent off-pump CABG at Emory University School of Medicine, Atlanta, Georgia, United States. "This period included the entire off-pump experience at Emory, including the learning curve," said John Puskas, MD, Chief of Cardiac Surgery and Professor of Surgery at the university.

Dr. Puskas presented the study's findings in an oral presentation on January 28 at the Society of Thoracic Surgeons 44th Annual Meeting (STS).

Study patients were assessed for 40 different possible risk factors for surgery, including STS score for mortality propensity, gender, and year of surgery.

Female patients (3,710) were older, with an average age of 54.9 months compared with 9,102 men, whose average age was 61.8 years, a statistically significant difference (P <.001). Women in the study also had a higher STS score compared with men (3.2% vs 1.8%, P <.001). The 5,667 patients who underwent off-pump surgery were older than the 7,145 who had conventional on-pump CABG (63 vs 62.4 years, P =.003).

Women who had off-pump surgery had a higher STS score than women who had on-pump surgery (3.3% vs 3%, P =.021).

In the early outcomes, 4.1% of the females operated on pump died compared with 1.6% of women operated off pump (P <.001). Stroke rates were significantly higher in on-pump patients as was major acute coronary events; heart attacks occurred more frequently with on-pump surgery, but the difference did not reach statistical significance.

"The odds of death for women on-pump were significantly higher than for females treated with off-pump CABG [P =.005]," said Dr. Puskas.

"Off-pump CABG benefits women disproportionately," he said, "and reduces the gender disparity in early clinical outcomes after CABG."


[Presentation title: Offpump Coronary Bypass Grafting Is Associated With Reduced Operative Mortality and Morbidity and Is Equivalent to On-Pump CABG in 10-Year Survival. Abstract 29]

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