Five-year follow-up of a randomized comparison between off-pump and on-pump stable multivessel coronary artery bypass grafting. The MASS III trial

Abstract

Background—Coronary artery bypass graft surgery with cardiopulmonary bypass is a safe, routine procedure. Neverthe- less, significant morbidity remains, mostly because of the body’s response to the nonphysiological nature of cardiopulmonary bypass. Few data are available on the effects of off-pump coronary artery bypass graft surgery (OPCAB) on cardiac events and long-term clinical outcomes. Methods and Results—In a single-center randomized trial, 308 patients undergoing coronary artery bypass graft surgery were randomly assigned: 155 to OPCAB and 153 to on-pump CAB (ONCAB). Primary composite end points were death, myocardial infarction, further revascularization (surgery or angioplasty), or stroke. After 5-year follow-up, the primary composite end point was not different between groups (hazard ratio 0.71, 95% CI 0.41 to 1.22; Pϭ0.21). A statistical difference was found between OPCAB and ONCAB groups in the duration of surgery (240Ϯ65 versus 300Ϯ87.5 minutes; PϽ0.001), in the length of ICU stay (19.5Ϯ17.8 versus 43Ϯ17.0 hours; PϽ0.001), time to extubation (4.6Ϯ6.8 versus 9.3Ϯ5.7 hours; PϽ0.001), hospital stay (6Ϯ2 versus 9Ϯ2 days; PϽ0.001), higher incidence of atrial fibrillation (35 versus 4% of patients; PϽ0.001), and blood requirements (31 versus 61% of patients; PϽ0.001), respectively. The number of grafts per patient was higher in the ONCAB than the OPCAB group (2.97 versus 2.49 grafts/patient; PϽ0.001). Conclusions—No difference was found between groups in the primary composite end point at 5-years follow-up. Although OPCAB surgery was related to a lower number of grafts and higher episodes of atrial fibrillation, it had no significant implications related to long-term outcomes.