5 Years Results of Off-Pump VS On-Pump CABGProspective Non-randomized Comparative Study Piya Cherntanomwong*, Panuwat Lertsithichai*, Somchai Viengteerawat**, Suchart Chaiyaroj*. *Cardiothoracic surgery unit, Department of surgery **Department of Anesthesiology Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok,Thailand.
Objectives • 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 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.
Average serum CKMB plotted against time after operation for on-pump versus off-pump CABG
Kaplan-Meier Estimates: On Pump vs. Off Pump 1.00 0.75 Survival Probability 0.50 0.25 0.00 0 20 40 60 80 Time since operation (months) 5 Years Survival of Off Pump VS On Pump 96% Off Pump 95% On Pump 170 164 150 65 13
Conclusion • 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” Thank you