Table 1. Impact of OPCAB on long-term survival and outcomes: current best available evidence.
| Author, date and Journal | Title | Study population | Main outcomes | Key findings |
|---|---|---|---|---|
| Angelini et al. (21) [2009], J Thorac Cardiovasc Surg | Effects of on- and off-pump coronary artery surgery on graft patency, survival, and health-related quality of life: long-term follow-up of 2 randomized controlled trials | 401 patients from two different prospective randomized controlled trials (BHACAS 1 and 2); 200 OPCAB (mean follow up: 6.3 years); 201 ONCAB (mean follow up: 6.4 years) |
Survival | No difference between ONCAB vs. OPCAB cohorts (HR =1.24; 95% CI, 0.72–2.15; P=0.44) |
| Graft patency | No difference in the likelihood of graft occlusion between OPCAB vs. ONCAB groups (OR =1.00; 95% CI, 0.55–1.81; P>0.99) | |||
| Benedetto et al. (24) [2016], J Thorac Cardiovasc Surg | Off-pump versus on-pump coronary artery bypass surgery in patients with actively treated diabetes and multivessel coronary disease | Retrospective analysis of 2,450 actively treated diabetic patients undergoing OPCAB versus ONCAB (1,493 subjects were orally treated and 1,011 were on insulin) (1,253 OPCAB and 1,197 ONCAB); propensity score matching was used to compare the two matched groups; mean follow up: over 10 years |
Survival; complete revascularization | OPACB did not significantly affect late mortality (HR =1.08; 95% CI, 0.92–1.28; P=0.32). However, OPCAB with incomplete revascularization was associated with a reduced survival rate when compared to OPCAB with complete revascularization (HR =1.82; 95% CI, 1.34–2.46; P=0.0002) and ONCAB with complete revascularization (HR =1.83; 95% CI, 1.36–2.47; P<0.0001) |
| Di Mauro et al. (11) [2007], Ann Thorac Surg | Does off-pump coronary surgery reduce postoperative acute renal failure? The importance of preoperative renal function | Retrospective cohort study of 2,833 patients (normal renal function: 1,724; abnormal renal function: 160) (942 OPCAB and 942 ONCAB); mean follow up: 7.5 years |
Survival | OPCAB provides better late outcomes in patients with normal creatinine preoperatively |
| Late outcomes | Surgical strategy does not affect late mortality in the overall population. Ten-year mortality ONCAB (7.0%) vs. OPCAB (5.3%) (HR =1.3; 95% CI, 0.91–1.9; P=0.141) | |||
| Raja et al. (25) [2013], Biomed Res Int | Does off-pump coronary artery bypass grafting negatively impact long-term survival and freedom from reintervention? | Retrospective cohort study of 704 consecutive patients (single centre) (307 OPCAB and 397 ONCAB); follow-up: 10 years |
Survival | OPCAB compared with ONCAB does not adversely impact survival (HR =0.91; 95% CI, 0.70–1.12; P=0.87) |
| Need for repeat intervention | Freedom from re-intervention (HR =0.93; 95%CI, 0.87–1.05) compared with ONCAB | |||
| Puskas et al. (3) [2011], Ann Thorac Surg | Off-pump and on-pump coronary artery bypass patency, myocardial ischemia, and freedom from reintervention: long-term follow-up | Prospective, randomized controlled trial (SMART); 297 patients (98 OPCAB and 99 ONCAB); mean follow up: 7.5 years |
Long-term survival; graft patency; need for re-intervention | At 5-year follow-up, long term survival was statistically significant in favour of OPCAB (92.9% OPCAB vs. 81.8% CPB; P=0.02). However, by 7-year follow-up, this difference was no longer statistically significant (83.7% OPCAB vs. 73.7% CPB; P=0.09), and the two overall survival curves were not statistically different (P=0.33); other outcomes were similar between OPCAB vs. ONCAB |
| Kirmani et al. (26) [2016], Ann Thorac Surg | Long-term survival after off-pump coronary artery bypass grafting | Retrospective cohort study; single centre; 2,082 OPCAB and 2,082 ONCAB; median follow-up: 7.0 years |
Long term survival | OPCAB group fewer in hospital cerebrovascular complications, mean number of grafts higher in the ONCAB. long-term survival was similar between groups |
| Hueb et al. (27) [2010], Circulation | Five-year follow-up of a randomized comparison between off-pump and on-pump stable multivessel coronary artery bypass grafting. The MASS III trial | Prospective, randomized controlled trial of 308 patients (155 OPCAB and 153 ONCAB); follow up: 5 years |
Survival; graft patency | No difference in death, myocardial infarction or further revascularization was found between groups, number of grafts per patient was higher in the ONCAB |
| Robertson et al. (19) [2013], J Thorac Cardiovasc Surg | Complete revascularization is compromised in off-pump coronary artery bypass grafting | Retrospective cohort study of 1,285 patients (308 OPCAB and 308 ONCAB); follow up: 10 years |
Long term survival; freedom from cardiac readmission | Complete revascularization and rate of total arterial grafting significantly higher in ONCAB, no difference in survival or freedom from cardiac cause and hospital readmission |
| Bakaeen et al. (16) [2013], Ann Thorac Surg | Off-pump may compromise long-term survival in a veteran population | Large, multicentre, retrospective review; total 65,097 patients (11,627 OPCAB and 53,468 ONCAB); follow up: 5 and 10 years |
Survival (matched patients) | OPCAB vs. ONCAB (all-cause mortality): overall HR=1.06; 95% CI, 1.00–1.13; P=0.036; ONCAB may be associated with increased long-term survival |
| Filardo et al. (17) [2011], Ann Thorac Surg | Comparing long-term survival between patients undergoing off-pump and on-pump coronary | Retrospective cohort study, total 8,081 patients (732 OPCAB and 7,349 ONCAB); follow up: 5 and 10 years |
Survival | Long-term survival following on-pump CABG is significantly greater; at 5 years: 77.4% OPCAB vs. 80.8% ONCAB (P<0.05); at 10 years: 54.7% OPCAB vs. 62.3% ONCAB (P<0.05) |
OPCAB, off pump coronary bypass; ONCAB, on pump coronary bypass; HR, hazard ratio; OR, odds ratio; CPB, cardiopulmonary bypass; CI, confidential interval.