RESUMO
BACKGROUND: After more than a decade of experience with off-pump coronary bypass surgery, still no consensus exists concerning its benefit on clinical outcome compared to the on-pump technique. In this 12-month follow-up, we compare off-pump and on-pump surgery on the appearance of graft patency, myocardial function, and clinical outcome. METHODS: One hundred twenty patients were randomized to off-pump or on-pump coronary surgery. Angiography was performed intraoperatively, at 3 and 12 months. Global myocardial function was estimated by magnetic resonance imaging (MRI) preoperatively and 12 months postoperatively, as well as functional class and stress testing. RESULTS: After 12 months internal mammary artery patency was 94% in the off-pump group and 96% in the on-pump group. Vein graft patency was 80% and 87%, respectively. No statistically significant difference between the two groups existed. There were no differences in exercise capacity improvement and attenuation of symptoms between the groups. CONCLUSIONS: At 12-months follow-up, off-pump coronary bypass surgery provided the same angiographic graft patency as the on-pump technique. Improvement in functional class and exercise capacity was the same in both groups.
Assuntos
Angiografia Coronária , Ponte de Artéria Coronária sem Circulação Extracorpórea/estatística & dados numéricos , Reestenose Coronária/epidemiologia , Idoso , Angina Pectoris/epidemiologia , Reestenose Coronária/diagnóstico por imagem , Teste de Esforço , Feminino , Seguimentos , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/epidemiologia , Humanos , Anastomose de Artéria Torácica Interna-Coronária , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Veia Safena/transplante , Método Simples-Cego , Resultado do TratamentoRESUMO
Abstract Background: Off-pump coronary artery bypass surgery has emerged as an alternative technique to traditional onpump surgery. The aim of this randomized study was to compare perioperative morbidity and mortality and intraoperative and short-term graft patency in off-pump and on-pump coronary artery bypass grafting. Methods: One hundred twenty patients were randomized for coronary revascularization with or without cardiopulmonary bypass. In all patients grafts and anastomoses were monitored with transit time Doppler ultrasonography and angiography. Angiography was repeated 3 months after the procedure in 115 of the patients. Results: Angiography 3 months postoperatively revealed that internal mammary artery patency was 98% in both groups. Vein graft patency was 83% in the off-pump group and 91% in the on-pump group, a difference that was not statistically significant. One perioperative death was recorded in each group. Two strokes were recorded in the on-pump group, none in the off-pump group. Conclusion: In this prospective, controlled study, perioperative and short-term outcome of off-pump coronary surgery equaled that of on-pump surgery.