OFF-PUMP CORONARY ARTERY BYPASS GRAFTING: 1500 PATIENTS AND MORE THAN 20 YEARS OF FOLLOW-UP

There is renewed interest in off-pump coronary artery bypass grafting (OPCABG) in the past years. Most series looking at the long-term outcomes of CABG often include patients who were operated on and off pump. Moreover, few studies have looked at the outcomes of these patients up to 20 years. We sought to examine the very long-term outcomes of patients undergoing OPCABG.

Between 1996 and 2008, 1500 patients underwent OPCABG in our institution. Data from these patients were collected prospectively. The mean follow-up is 12±6 years and is 95% complete. The primary endpoint was survival, which was compared to that of the sex- and age-matched population. The secondary endpoint was the cumulative incidence of coronary reintervention (surgical or percutaneous). The mean age of the cohort is 65±10 years and 79% of patients are male. Patients presented with the following comorbidities: 31% were diabetics, 12% had COPD, 20% had PAD, 27% had a depressed ejection fraction, 37% had CKD and 31% had a BMI>30 kg/m2. Multi-arterial OPCAG was performed in 40% of patients. At least 1 radial artery was used in 107 patients (7%) and bilateral internal mammary arteries were used in 431 patients (29%). During the study follow-up, 789 patients died. Cause of death was non-cardiac in 42% of them. At 5, 10, 20 and 20 years, the survival was 87.6±1.7%, 72.0±2.4%, 53.8±2.7% and 35.5±3.0%. Survival was lower than that of the sex- and age-matched population. A total of 162 patients required a coronary reintervention during the study follow-up. At 5, 10, 15 and 20 years, the cumulative incidence of coronary artery reintervention was 4.3±0.5%, 7.4±0.7%, 10.4±0.8% and 13.1±1.0%, respectively.

In this large cohort of patients undergoing OPCABG, survival started to diverge from that of the sex- and age-matched population after ≈5 years. The cumulative incidence of coronary reintervention is low, even up to 20 years. These data may help to better inform treatment in patients requiring CABG.