Comparison of Graft Patency between On-pump and Off-pump Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Chang , LIU Zonghong , XIAO Xigang , Zhu Kai , MA Liyuan , YU Hui , XU Lei , LIU Hongyu.

1. Department of Cardiovascular　Surgery，the First Affiliated Hospital of Harbin Medical University，Harbin 150001，P. R. China 2. Department of Computed　Tomography，the First Affiliated Hospital of Harbin Medical University，Harbin 150001，P. R. China;

Corresponding author：

Keywords：

Coronary artery bypass grafting; 　Graft vessel; 　Graft patency rate; 　Cardiopulmonary bypass

DOI：

10.7507/1007-4848.20130089

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Objective To compare the graft patency rates of conventional on-pump coronary artery bypass grafting （CCABG） and off-pump coronary artery bypass grafting （OPCAB） at 2 weeks，3 months and 1 year after surgery. Methods　Clinical data of 200 patients who underwent coronary artery bypass grafting （CABG） in the First Affiliated Hospital of Harbin　Medical University from May 2010 to November 2011 were retrospectively analyzed. All the 200 patients were divided into two groups according to different surgical procedures they received：CCABG group，61 patients including 32 male patients and 29 female patients with their age of 59.8±4.7 years；and OPCAB group，139 patients including 72 male patients and 67 female patients with their age of 59.6±8.9 years. Graft patency of all the patients was evaluated by 256-slice multislice computed tomography angiography （256-MSCTA） at 2 weeks，3 months and 1 year after CABG and compared between two groups. Results At 2 weeks，3 months and 1 year after CABG，the graft patency rates of left internal mammary artery （LIMA） grafting were not statistically different between CCABG group and OPCAB group，as well as those of great saphenous vein （GSV） grafting （P＞0.05）. The 1 year graft patency rates of LIMA grafting of CCABG group and OPCAB　group were 92.31% and 91.94% respectively，and 1 year graft patency rates of GSV grafting of CCABG group and OPCAB group were 91.35% and 90.00% respectively. To compare the graft patency rates of different distal anastomotic locations，grafting to the left anterior descending （LAD） coronary artery had significantly higher patency rate than grafting to the right coronary artery （RCA，P＜0.05）. The 1 year graft patency rates of LAD grafting and RCA grafting were 97.78% and 85.90% respectively. But there was no statistical difference in graft patency rates at different respective distal anastomotic locations between OPCAB group and CCABG group （P＞0.05）. To compare early clinical outcomes of two groups，postoperative mechanical ventilation time，length of ICU stay，24-hour mediastinal drainage，24-hour blood transfusion，length of hospital stay，and hospitalization cost of OPCAB group were significantly shorter or lower than those of CCABG group （P＜0.05）. Conclusion Short-term graft patency rates of CCABG and OPCAB are quite similar. Patency rate of grafting to LAD is higher than that of grafting to RCA. OPCAB can produce better perioperative clinical outcomes than CCABG.

Citation： LIU Chang,LIU Zonghong,XIAO Xigang,Zhu Kai,MA Liyuan,YU Hui,XU Lei,LIU Hongyu.. Comparison of Graft Patency between On-pump and Off-pump Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(3): 289-293. doi: 10.7507/1007-4848.20130089 Copy

1.	outcomes and in long-term mortality and need for subsequent revascularization. Circulation， 2007， 116 （10）：1145-1152.
2.	程兆云，赵子牛，权晓强，等. 体外与非体外循环冠状动脉旁路移植术698例. 中国胸心血管外科临床杂志， 2009， 16 （6）：430-434.
3.	Sellke FW， DiMaio JM， Caplan LR， et al. Comparing on-pump and off-pump coronary artery bypass grafting：numerous studies but few conclusions：a scientific statement from the American Heart Association　council on cardiovascular surgery and anesthesia in collaboration with the interdisciplinary working group on quality of care and outcomes research. Circulation， 2005，111 （21）：2858-2864.
4.	Hannan EL， Chuntao WU， Smith CR， et al. Off-pump versus　on-pump coronary artery bypass graft surgery：differences in short-term.
5.	Karolak W， Hirsch G， Buth K， et al. Medium-term outcomes of coronary artery bypass graft surgery on pump versus off pump：results from a randomized controlled trial. Am Heart J， 2007， 153 （4）：689-695.
6.	Raja SG， Dreyfus GD. Off-pump coronary artery bypass surgery：to do or not to do ? Current best available evidence. J Cardiothorac Vasc Anesth， 2004， 18 （4）：486-505.
7.	刘志勇，高长青，李伯君，等. 64排CT对冠状动脉旁路移植术后桥血管病变的诊断研究. 中华外科杂志， 2008， 46 （4）：245-247.
8.	Meyer TS， Martinoff S， Hadamitzky M， et al. Improved noninvasive　assessment of coronary artery bypass grafts with 64-slice computed tomographic angiography in an unselected patient population. J Am Coll Cardiol， 2007， 49 （9）：946-950.
9.	李鹏雨，李坤成，杜祥颖，等. 64层螺旋CT在冠状动脉搭桥术后随访中的初步应用. 放射学实践， 2007， 22 （4）：376-379.
10.	Lytle BW， Loop FD， Cosgrove DM， et al. Long-term （5 to 12 years） serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg， 1985， 89 （2）：248-258.
11.	Khan NE， De Souza A， Mister R， et al. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med， 2004，350 （1）：21-28.
12.	Al-Ruzzeh S， George S， Bustami M， et al. The early clinical and　angiographic outcome of sequential coronary artery bypass grafting with the off-pump technique. J Thorac Cardiovasc Surg， 2002， 123 （3）：525-530.
13.	Puskas JD， Williams WH， Mahoney EM， et al. Off-pump vs conven-tional coronary artery bypass grafting：early and 1-year graft patency， cost， and quality-of-life outcomes：a randomized trial. JAMA， 2004， 291 （15）：1841-1849.
14.	Widimsky P， Straka Z， Stros P， et al. One-year coronary bypass graft patency：a randomized comparison between off-pump and　on-pump surgery angiographic results of the PRAGUE-4 trial.Circulation， 2004， 110 （22）：3418-3423.
15.	Gao G， Zheng Z， Pi Y， et al. Aspirin plus clopidogrel therapy increases　early venous graft patency after coronary artery bypass surgery a single-center， randomized， controlled trial. J Am Coll Cardiol， 2010， 56 （20）：1639-1643.
16.	刘畅，肖喜刚，王柏春，等. 冠状动脉旁路移植术后桥血管通畅率的影响因素分析. 中国胸心血管外科临床杂志， 2012， 19 （6）：606-609.
17.	Mitka M. Beat goes on in"off-pump. bypass surgery：surgeon experience may be key to best outcome. JAMA， 2004， 291 （15）：1821-1822.
18.	王明岩，高长青，王刚，等. 非体外循环冠状动脉旁路移植术后大隐静脉序贯桥与单支桥中期通畅率的比较. 中国胸心血管外科临床杂志， 2011， 18 （5）：399-403.
19.	Kandemir O， Tokmakoglu H， Tezcaner T， et al. Right coronary system grafts：alone or together with left system grafts_angiographic results. Ann Thorac Cardiovasc Surg， 2007， 13 （1）：27-31.
20.	Omero?lu SN， Kirali K， Güler M， et al. Midterm angiographic　assessment of coronary artery bypass grafting without cardiopulmonary　bypass. Ann Thorac Surg， 2000， 70 （3）：844-849.
21.	Lund O， Christensen J， Holme S， et al. On-pump versus off-pump coronary artery bypass：Independent risk factors and off-pump graft patency. Eur J Cardiothorac Surg， 2001， 20 （5）：901-907.
22.	Mckay RG， Mennett RA， Gallagher RC， et al. A comparison of　on-pump vs. off-pump coronary artery bypass surgery among low， intermediate， and high-risk patients：the Hartford Hospital experience. Conn Med， 2001， 65 （9）：515-521.
23.	Hernandez F， Cohn WE， Baribeau YR， et al. In-hospital outcomes of off-pump versus on-pump coronary artery bypass procedures：a multicenter experience. Ann Thorac Surg， 2001， 72 （5）：1528-1533.
24.	张杰民，刘晓程，靖文斌. 非体外循环和体外循环高龄冠状动脉旁路移植术临床分析比较. 心肺血管病杂志， 2010， 29 （4）：308-311.
25.	柏本健，魏维强，解洪涛，等. 体外循环和非体外循环冠状动脉旁路移植术的早期疗效比较. 中国胸心血管外科临床杂志， 2010， 17 （3）：244-246.
26.	Puskas JD， Thourani VH， Marshall JJ， et al. Clinical outcomes， angiographic patency， and resource utilization in 200 consecutive　off-pump coronary bypass patients. Ann Thorac Surg， 2001， 71 （5）：1477-1483.
27.	Puskas JD， Williams WH， Duke PG， et al. Off-pump coronary artery　bypass grafting provides complete revascularization with reduced myocardial injury， transfusion requirements， and length of stay：a prospective randomized comparison of two hundred unselected patients　undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg， 2003， 125 （4）：797-808.

1. outcomes and in long-term mortality and need for subsequent revascularization. Circulation， 2007， 116 （10）：1145-1152.
2. 　程兆云，赵子牛，权晓强，等. 体外与非体外循环冠状动脉旁路移植术698例. 中国胸心血管外科临床杂志， 2009， 16 （6）：430-434.
3. 　Sellke FW， DiMaio JM， Caplan LR， et al. Comparing on-pump and off-pump coronary artery bypass grafting：numerous studies but few conclusions：a scientific statement from the American Heart Association　council on cardiovascular surgery and anesthesia in collaboration with the interdisciplinary working group on quality of care and outcomes research. Circulation， 2005，111 （21）：2858-2864.
4. 　Hannan EL， Chuntao WU， Smith CR， et al. Off-pump versus　on-pump coronary artery bypass graft surgery：differences in short-term.
5. 　Karolak W， Hirsch G， Buth K， et al. Medium-term outcomes of coronary artery bypass graft surgery on pump versus off pump：results from a randomized controlled trial. Am Heart J， 2007， 153 （4）：689-695.
6. 　Raja SG， Dreyfus GD. Off-pump coronary artery bypass surgery：to do or not to do ? Current best available evidence. J Cardiothorac Vasc Anesth， 2004， 18 （4）：486-505.
7. 　刘志勇，高长青，李伯君，等. 64排CT对冠状动脉旁路移植术后桥血管病变的诊断研究. 中华外科杂志， 2008， 46 （4）：245-247.
8. 　Meyer TS， Martinoff S， Hadamitzky M， et al. Improved noninvasive　assessment of coronary artery bypass grafts with 64-slice computed tomographic angiography in an unselected patient population. J Am Coll Cardiol， 2007， 49 （9）：946-950.
9. 　李鹏雨，李坤成，杜祥颖，等. 64层螺旋CT在冠状动脉搭桥术后随访中的初步应用. 放射学实践， 2007， 22 （4）：376-379.
10. 　Lytle BW， Loop FD， Cosgrove DM， et al. Long-term （5 to 12 years） serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg， 1985， 89 （2）：248-258.
11. 　Khan NE， De Souza A， Mister R， et al. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med， 2004，350 （1）：21-28.
12. 　Al-Ruzzeh S， George S， Bustami M， et al. The early clinical and　angiographic outcome of sequential coronary artery bypass grafting with the off-pump technique. J Thorac Cardiovasc Surg， 2002， 123 （3）：525-530.
13. 　Puskas JD， Williams WH， Mahoney EM， et al. Off-pump vs conven-tional coronary artery bypass grafting：early and 1-year graft patency， cost， and quality-of-life outcomes：a randomized trial. JAMA， 2004， 291 （15）：1841-1849.
14. 　Widimsky P， Straka Z， Stros P， et al. One-year coronary bypass graft patency：a randomized comparison between off-pump and　on-pump surgery angiographic results of the PRAGUE-4 trial.Circulation， 2004， 110 （22）：3418-3423.
15. 　Gao G， Zheng Z， Pi Y， et al. Aspirin plus clopidogrel therapy increases　early venous graft patency after coronary artery bypass surgery a single-center， randomized， controlled trial. J Am Coll Cardiol， 2010， 56 （20）：1639-1643.
16. 　刘畅，肖喜刚，王柏春，等. 冠状动脉旁路移植术后桥血管通畅率的影响因素分析. 中国胸心血管外科临床杂志， 2012， 19 （6）：606-609.
17. 　Mitka M. Beat goes on in"off-pump. bypass surgery：surgeon experience may be key to best outcome. JAMA， 2004， 291 （15）：1821-1822.
18. 　王明岩，高长青，王刚，等. 非体外循环冠状动脉旁路移植术后大隐静脉序贯桥与单支桥中期通畅率的比较. 中国胸心血管外科临床杂志， 2011， 18 （5）：399-403.
19. 　Kandemir O， Tokmakoglu H， Tezcaner T， et al. Right coronary system grafts：alone or together with left system grafts_angiographic results. Ann Thorac Cardiovasc Surg， 2007， 13 （1）：27-31.
20. 　Omero?lu SN， Kirali K， Güler M， et al. Midterm angiographic　assessment of coronary artery bypass grafting without cardiopulmonary　bypass. Ann Thorac Surg， 2000， 70 （3）：844-849.
21. 　Lund O， Christensen J， Holme S， et al. On-pump versus off-pump coronary artery bypass：Independent risk factors and off-pump graft patency. Eur J Cardiothorac Surg， 2001， 20 （5）：901-907.
22. 　Mckay RG， Mennett RA， Gallagher RC， et al. A comparison of　on-pump vs. off-pump coronary artery bypass surgery among low， intermediate， and high-risk patients：the Hartford Hospital experience. Conn Med， 2001， 65 （9）：515-521.
23. 　Hernandez F， Cohn WE， Baribeau YR， et al. In-hospital outcomes of off-pump versus on-pump coronary artery bypass procedures：a multicenter experience. Ann Thorac Surg， 2001， 72 （5）：1528-1533.
24. 　张杰民，刘晓程，靖文斌. 非体外循环和体外循环高龄冠状动脉旁路移植术临床分析比较. 心肺血管病杂志， 2010， 29 （4）：308-311.
25. 　柏本健，魏维强，解洪涛，等. 体外循环和非体外循环冠状动脉旁路移植术的早期疗效比较. 中国胸心血管外科临床杂志， 2010， 17 （3）：244-246.
26. 　Puskas JD， Thourani VH， Marshall JJ， et al. Clinical outcomes， angiographic patency， and resource utilization in 200 consecutive　off-pump coronary bypass patients. Ann Thorac Surg， 2001， 71 （5）：1477-1483.
27. 　Puskas JD， Williams WH， Duke PG， et al. Off-pump coronary artery　bypass grafting provides complete revascularization with reduced myocardial injury， transfusion requirements， and length of stay：a prospective randomized comparison of two hundred unselected patients　undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg， 2003， 125 （4）：797-808.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of Graft Patency between On-pump and Off-pump Coronary Artery Bypass Grafting

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