Off-pump CABG More Cost Effective than Conventional Bypass Surgery

Avoiding cardiopulmonary bypass during coronary artery bypass grafting (CABG) does not improve the clinical outcomes of low-risk patients, but it is more cost effective than on-pump surgery, according to a report published in the January 30th issue of The New England Journal of Medicine.

Dr. Peter P. T. de Jaegere, from the University Medical Center Utrecht in the Netherlands, and colleagues assessed the outcomes of 281 patients with coronary disease who were randomized to undergo on- or off-pump CABG. All of the patients had predominantly single- or double-vessel disease.

At 1 year after surgery, the percentage of patients who had not experienced any major adverse events, such as death, stroke or myocardial infarction, was similar in each group–about 90%. Moreover, graft patency was comparable in each group, at 93% in the on-pump group and 91% in the off-pump group.

While clinical outcomes were similar for both methods, off-pump surgery was more cost effective than on-pump surgery. On-pump surgery cost about $1839 more than off-pump surgery, but was associated with only a marginal increase in quality-adjusted years of life.

Given that off-pump surgery was as effective as on-pump surgery, but less costly, the former may represent a viable alternative to conventional CABG, the authors note.

In a related editorial, Dr. Eric A. Rose, from Columbia University in New York, notes that there is a paucity of data regarding the benefits of off-pump CABG in high-risk patients, who are actually more common than low-risk patients.

“Until such data are available, we will not know whether off-pump bypass surgery is a step forward, backward, or sideways,” Dr. Rose states.

N Engl J Med 2003;348:379-380,394-402.