Results from a randomized, prospective study comparing off-pump coronary
artery bypass surgery with and without the cardiopulmonary bypass pump
provided mixed reviews of the outcomes of the two techniques. Although
off-pump surgery was found as safe as on-pump surgery, graft patency
appeared more durable in the on-pump group that received a more classical
form of surgery, said researchers in a report in the January 1, 2004, issue
of The New England Journal of Medicine ( N Engl J Med.
2004;350:21-28[Abstract/Free Full Text]).
In this study by British and Swiss researchers, 50 patients were randomly assigned to undergo on-
pump coronary artery bypass grafting and 54 to receive off-pump surgery. Three months after the
surgery, all patients underwent coronary angiography to determine graft patency. At that time, 127
of the 130 grafts received by the on-pump group were patent. In contrast, 114 of the 130 grafts
received by the off-pump group were patent. The researchers wrote: "In this randomized study, off-
pump coronary surgery was as safe as on-pump surgery and caused less myocardial damage. However, the
graft-patency rate was lower at three months in the off-pump group than in the on-pump group, and
this difference has implications with respect to the long-term outcome."
In an accompanying perspective (N Engl J Med. 2004;350:3-4), Thomas E. MacGillivray, MD, and Gus
J. Vlahakes, MD, from the Division of Cardiac Surgery, Massachusetts General Hospital, Boston,
wrote: "The surgical treatment options must be tailored to each patient in order to optimize the
benefits and minimize the risk of detrimental effects. In deciding whether or not to use the pump,
surgeons should consider which intervention would maximize the long-term benefits of coronary-
artery revascularization while minimizing the risks. . . . Methods of treatment should not compete
for patients but should be selected according to individual patients' needs in order to optimize
their care."