Off-Pump CABG as Effective as Conventional Bypass Surgery, But Less Costly
Off-pump CABG is comparable to conventional bypass surgery in terms of early and 1-year graft patency and quality-of-life outcomes, according to a report in the Journal of the American Medical Association for April 21st. However, the hospital cost for off-pump surgery is about $2000 less than that of conventional surgery.
These findings are similar to those reported last year by a team of Dutch researchers, lead author Dr. John D. Puskas, from Emory University in Atlanta, told Reuters Health (see Reuters Health report January 29, 2003). What distinguishes the current study from others is the use of unselected patients and the evaluation of long-term graft patency, he added.
In a report published last year, “we showed that off-pump CABG was associated with better in-hospital outcomes than standard bypass surgery,” Dr. Puskas noted. “Using the same group of patients, we now show that 1-year graft patency is similar with both types of surgery.”
“Our first paper showed these great benefits for off-pump CABG. But in the back of their mind, people were still wondering if the results were durable,” Dr. Puskas said. “That’s what this second paper answers.”
The study involved 200 patients with coronary artery disease who were randomized to undergo on- or off-pump CABG. All of the operations were performed by Dr. Puskas. The number of patients with complete follow-up was 197 at 30 days and 185 at 1 year.
At 30 days, the graft patency rate for off-pump CABG, at 99.0%, was actually slightly higher than that seen with conventional surgery, at 97.7%. The corresponding patency rates at 1 year were 93.6% and 95.8% (p = NS).
The on- and off-pump groups also had similar risks of death, stroke, myocardial infarction, angina, re-intervention at 30 days and 1 year. Moreover, no difference was seen between the groups in health-related quality of life.
The average hospital cost per patient for off-pump CABG was $2272 less than that of on-pump surgery at 30 days and $1955 less at 1 year, the researchers report.
One important question is whether the current results can “be extrapolated to the larger community of experienced cardiac surgeons in practice,” Dr. Eric D. Peterson and Dr. Daniel B. Mark, from Duke University Medical Center in Durham, North Carolina, note in a related editorial. The present study involved just one surgeon who is considered a pioneer of off-pump surgery, they point out.
Dr. Puskas agreed that there is the issue of generalizability given the procedure’s relatively steep learning curve. To establish off-pump CABG as the standard for bypass surgery, the current findings will need to be replicated in a large multicenter trial involving surgeons with extensive experience in both on- and off-pump surgery, he said.
JAMA 2004;291:1841-1849,1897-1899.
