CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

November 4th, 2009

Have We Been Off Track With Off-Pump CABG?

Off-pump CABG has been heralded as being superior to on-pump CABG, with the contention that it reduces the occurrence of the dreaded complications of cardiopulmonary bypass (stroke and neurocognitive deficits) and utilizes fewer medical resources.  However, the data supporting this contention are scant.
 
Now, a large randomized study of off-pump versus on-pump CABG in 2203 patients at 18 Veterans Affairs medical centers shows a worse outcome with the off-pump procedure.  After 1 year, the off-pump CABG patients were more likely to experience death, myocardial infarction, or required repeat revascularization and were less likely to have complete revascularization and patent grafts when compared to those undergoing traditional on-pump surgery.  Furthermore, off-pump CABG did not improve neuropsychological outcomes or result in reduced time on a ventilator or stay in the ICU or hospital. 
 
Is this the death of off-pump CABG?
 
Should we discourage our patients from having off-pump CABG?
 
Is this a problem with the off-pump procedure or just inadequate experience by the surgeon(s)? An accompanying editorial raises this issue.
 

Categories: General


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