Ten-year outcomes after off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial
<p><strong>Objective</strong> We performed a post hoc analysis of the Arterial Revascularization Trial to compare 10-year outcomes after off-pump versus on-pump surgery.</p> <p><strong>Methods</strong> Among 3102 patients enrolled, 1252 (40% of total) and 1...
| Main Authors: | , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Elsevier
2020
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| _version_ | 1797089643952340992 |
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| author | Taggart, DP Gaudino, MF Gerry, S Gray, A Lees, B Sajja, LR Zamvar, V Flather, M Benedetto, U Arterial Revascularization Trial Investigators |
| author_facet | Taggart, DP Gaudino, MF Gerry, S Gray, A Lees, B Sajja, LR Zamvar, V Flather, M Benedetto, U Arterial Revascularization Trial Investigators |
| author_sort | Taggart, DP |
| collection | OXFORD |
| description | <p><strong>Objective</strong>
We performed a post hoc analysis of the Arterial Revascularization Trial to compare 10-year outcomes after off-pump versus on-pump surgery.</p>
<p><strong>Methods</strong>
Among 3102 patients enrolled, 1252 (40% of total) and 1699 patients received off-pump and on-pump surgery (151 patients were excluded because of other reasons); 2792 patients (95%) completed 10-year follow-up. Propensity matching and mixed-effect Cox model were used to compare long-term outcomes. Interaction term analysis was used to determine whether bilateral internal thoracic artery grafting was a significant effect modifier.</p>
<p><strong>Results</strong>
One thousand seventy-eight matched pairs were selected for comparison. A total of 27 patients (2.5%) in the off-pump group required conversion to on-pump surgery. The off-pump and on-pump groups received a similar number of grafts (3.2 ± 0.89 vs 3.1 ± 0.8; P = .88). At 10 years, when compared with on-pump, there was no significant difference in death (adjusted hazard ratio for off-pump, 1.1; 95% confidence interval, 0.84-1.4; P = .54) or the composite of death, myocardial infarction, stroke, and repeat revascularization (adjusted hazard ratio, 0.92; 95% confidence interval, 0.72-1.2; P = .47). However, off-pump surgery performed by low volume off-pump surgeons was associated with a significantly lower number of grafts, increased conversion rates, and increased cardiovascular death (hazard ratio, 2.39; 95% confidence interval, 1.28-4.47; P = .006) when compared with on-pump surgery performed by on–pump-only surgeons.</p>
<p><strong>Conclusions</strong>
The findings showed that in the Arterial Revascularization Trial, off-pump and on-pump techniques achieved comparable long-term outcomes. However, when off-pump surgery was performed by low-volume surgeons, it was associated with a lower number of grafts, increased conversion, and a higher risk of cardiovascular death.</p> |
| first_indexed | 2024-03-07T03:07:00Z |
| format | Journal article |
| id | oxford-uuid:b2e33c58-8ace-40ef-9989-a568741a6739 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T03:07:00Z |
| publishDate | 2020 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:b2e33c58-8ace-40ef-9989-a568741a67392022-03-27T04:15:00ZTen-year outcomes after off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization TrialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:b2e33c58-8ace-40ef-9989-a568741a6739EnglishSymplectic ElementsElsevier2020Taggart, DPGaudino, MFGerry, SGray, ALees, BSajja, LRZamvar, VFlather, MBenedetto, UArterial Revascularization Trial Investigators<p><strong>Objective</strong> We performed a post hoc analysis of the Arterial Revascularization Trial to compare 10-year outcomes after off-pump versus on-pump surgery.</p> <p><strong>Methods</strong> Among 3102 patients enrolled, 1252 (40% of total) and 1699 patients received off-pump and on-pump surgery (151 patients were excluded because of other reasons); 2792 patients (95%) completed 10-year follow-up. Propensity matching and mixed-effect Cox model were used to compare long-term outcomes. Interaction term analysis was used to determine whether bilateral internal thoracic artery grafting was a significant effect modifier.</p> <p><strong>Results</strong> One thousand seventy-eight matched pairs were selected for comparison. A total of 27 patients (2.5%) in the off-pump group required conversion to on-pump surgery. The off-pump and on-pump groups received a similar number of grafts (3.2 ± 0.89 vs 3.1 ± 0.8; P = .88). At 10 years, when compared with on-pump, there was no significant difference in death (adjusted hazard ratio for off-pump, 1.1; 95% confidence interval, 0.84-1.4; P = .54) or the composite of death, myocardial infarction, stroke, and repeat revascularization (adjusted hazard ratio, 0.92; 95% confidence interval, 0.72-1.2; P = .47). However, off-pump surgery performed by low volume off-pump surgeons was associated with a significantly lower number of grafts, increased conversion rates, and increased cardiovascular death (hazard ratio, 2.39; 95% confidence interval, 1.28-4.47; P = .006) when compared with on-pump surgery performed by on–pump-only surgeons.</p> <p><strong>Conclusions</strong> The findings showed that in the Arterial Revascularization Trial, off-pump and on-pump techniques achieved comparable long-term outcomes. However, when off-pump surgery was performed by low-volume surgeons, it was associated with a lower number of grafts, increased conversion, and a higher risk of cardiovascular death.</p> |
| spellingShingle | Taggart, DP Gaudino, MF Gerry, S Gray, A Lees, B Sajja, LR Zamvar, V Flather, M Benedetto, U Arterial Revascularization Trial Investigators Ten-year outcomes after off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial |
| title | Ten-year outcomes after off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial |
| title_full | Ten-year outcomes after off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial |
| title_fullStr | Ten-year outcomes after off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial |
| title_full_unstemmed | Ten-year outcomes after off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial |
| title_short | Ten-year outcomes after off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial |
| title_sort | ten year outcomes after off pump versus on pump coronary artery bypass grafting insights from the arterial revascularization trial |
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