Document Detail

Off-Pump coronary artery bypass surgery is associated with worse arterial and saphenous vein graft patency and less effective revascularization: Results from the Veterans Affairs Randomized On/Off Bypass (ROOBY) trial.
MedLine Citation:
PMID:  22592900     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) trial compared clinical and angiographic outcomes in off-pump versus on-pump coronary artery bypass graft (CABG) surgery to ascertain the relative efficacy of the 2 techniques.
METHODS AND RESULTS: From February 2002 to May 2007, the ROOBY trial randomized 2203 patients to off-pump versus on-pump CABG. Follow-up angiography was obtained in 685 off-pump (62%) and 685 on-pump (62%) patients. Angiograms were analyzed (blinded to treatment) for FitzGibbon classification (A=widely patent, B=flow limited, O=occluded) and effective revascularization. Effective revascularization was defined as follows: All 3 major coronary territories with significant disease were revascularized by a FitzGibbon A-quality graft to the major diseased artery, and there were no new postanastomotic lesions. Off-pump CABG resulted in lower FitzGibbon A patency rates than on-pump CABG for arterial conduits (85.8% versus 91.4%; P=0.003) and saphenous vein grafts (72.7% versus 80.4%; P<0.001). Fewer off-pump patients were effectively revascularized (50.1% versus 63.9% on-pump; P<0.001). Within each major coronary territory, effective revascularization was worse off pump than on pump (all P≤0.001). The 1-year adverse cardiac event rate was 16.4% in patients with ineffective revascularization versus 5.9% in patients with effective revascularization (P<0.001).
CONCLUSIONS: Off-pump CABG resulted in significantly lower FitzGibbon A patency for arterial and saphenous vein graft conduits and less effective revascularization than on-pump CABG. At 1 year, patients with less effective revascularization had higher adverse event rates.
CLINICAL TRIAL REGISTRATION: URL: Unique identifier: NCT00032630.
Brack Hattler; John C Messenger; A Laurie Shroyer; Joseph F Collins; Scott J Haugen; Joel A Garcia; Janet H Baltz; Joseph C Cleveland; Dimitri Novitzky; Frederick L Grover;
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2012-05-16
Journal Detail:
Title:  Circulation     Volume:  125     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-06-12     Completed Date:  2012-08-23     Revised Date:  2013-02-22    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2827-35     Citation Subset:  AIM; IM    
Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO 80220, USA.
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MeSH Terms
Coronary Angiography
Coronary Artery Bypass, Off-Pump / adverse effects*,  methods*
Coronary Disease / radiography,  surgery*
Follow-Up Studies
Graft Occlusion, Vascular / etiology*,  radiography
Graft Survival / physiology
Middle Aged
Myocardial Revascularization*
Radial Artery / physiology,  transplantation
Saphenous Vein / physiology,  transplantation
Vascular Patency / physiology
Comment In:
Circulation. 2013 Jan 15;127(2):e276   [PMID:  23319818 ]
Circulation. 2012 Jun 12;125(23):2806-8   [PMID:  22592901 ]

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