Transcript Comparison early results and midterm results between Off

5 Years Results of
Off-Pump VS On-Pump CABG
Prospective Non-randomized Comparative Study
Piya Cherntanomwong*, Panuwat Lertsithichai*,
Somchai Viengteerawat**, Suchart Chaiyaroj*.
*Cardiothoracic surgery unit, Department of surgery
**Department of Anesthesiology
Faculty of Medicine, Ramathibodi Hospital,
Mahidol University, Bangkok,Thailand.
Objectives
To review experience of off pump and on pump
CABG at our institute to compare early and longterm results and to determine the differences of
OPCAB and conventional CABG.
Prospective, Non-randomized Study
(Approved by Ethic Committee, Protocol ID : 06-51-03)
Baseline characteristics were compared
Primary Endpoint
Secondary Endpoint
Follow up to December 2008
The outcomes
Primary endpoints
• Operative mortality
• Bleeding and
Blood transfusion
• Myocardial injury
• Post operative AF
• Other post operative
complications
Secondary endpoints
•
•
•
•
•
•
Late death
MI
Stroke
PCI
Redo CABG
Sternal wound infection
Operative technique for Off Pump CABG
The intracoronary shunt
Octopus tissue stabilizer
Starfish heart positioner
(Medtronic Inc., Minneapolis, MN)
Data Analysis
Continuous data were compared between two independent
groups using unpaired t-test or Wilcoxon rank sum test as
appropriate, and categorical data were compared between
groups using the chi-square test.
The long-term probability of survival was estimated using the
Kaplan-Meier method. Cox proportional hazards models were
used to test the significance of prognostic factors for long-term
survival.
All statistical analyses were performed using Stata version 9
(Stata Corp, College Station, TX, USA). Statistical significance
was defined as a two-sided p-value of 0.05 or less.
Base-Line Characteristics of the Patients
Off pump
On pump
99 cases
71 cases
male
79
( 80% )
55
( 72% )
0.16 ( NS )
female
20
( 20% )
22
( 28% )
( NS )
Number pateints
Sex
170
cases
P-value
Age
60.873 + 8.46
60.515 + 11.72
0.83 ( NS )
BW
66.474 + 1.046
66.907 + 1.326
0.54 ( NS )
Previous HT
98
( 100 % )
77
( 99%)
( NS )
Previous DM
32
( 33% )
36
( 46%)
0.08 ( NS )
Previous MI
53
( 55% )
23
( 29%)
0.10 ( NS )
Previous CHF
42
( 43%)
25
( 32%)
0.13 ( NS )
Previous COPD
83
( 85%)
52
( 67%)
0.06 ( NS )
Previous CVA
6
( 6% )
9
( 11%)
0.21 ( NS )
Previous Renal dysfunction
44
( 46%)
21
( 27%)
0.15 ( NS )
Previous Renal failure
0
1
(1.4%)
( NS )
Previous Peripheral vascular disease
0
2
(2.8%)
( NS )
Previous AF
5
3
( 7%)
LVEF
42 + 8.8
43 + 12
0.56 ( NS )
Functional class
3+1
2.7 + 0.9
0.06 ( NS )
No. Vessel bypass
3.9 + 1.0
3.6 + 0.8
0.07 ( NS )
EuroSCORE (logistic)
4.2%
2.9%
0.05 ( NS )
( 5%)
0.32 ( NS )
Results of using blood transfusion and bleeding
On pump
P-value
Record ICD
mean 145 cc.
12 hr. median/range 100 ( 0 – 1360 ) cc.
201 cc.
140 ( 0 – 1160 ) cc.
< 0.001
PRC
mean 3. u
median/range 2 ( 0 – 6 ) u
4. u
2 ( 1 – 13 ) u
0.006
LPPC
mean 1. u
median/range 0 ( 0 – 4 ) u
6. u
0(0–8)u
0.001
FFP
mean 0.5 u
median/range 0 ( 0 – 5 ) u
3. u
( 0 – 10 ) u
0.001
Off pump
The results of using blood transfusion
(p < 0.05)
Average serum CKMB plotted against time after
operation for on-pump versus off-pump CABG
100
80
60
on pump
40
20
off pump
0
post
op
post
op 12
post
op 36
post
op 60
post
op 72
Results of Postoperative Complications
Off-pump
On-pump
Postoperative AF
10 ( 10% )
19 ( 24% ) 0.013
Postoperative Re-operation
1 (1%)
1 (1.4%)
NS
Postoperative MI
0
0
NS
Postoperative CVA
1 (1%)
0
NS
Postoperative Renal Failure
0
2 (2.8%)
NS
Postoperative Respiratory
Failure
0
2 (2.8%)
NS
Postoperative Sternum infection 1 (1%)
1 (1.4%)
NS
Postoperative Sepsis
0
0
NS
Mortality
1 (1%)
1 (1.4%)
NS
Complication
P-value
Results of 5 years outcomes
On pump (n = 71)
Off pump (n = 99)
p-value
Mean (SD)
58.2 (15.6)
53.8 (11.0)
0.032
Median (range)
63.7 (13.4 to 73.8)
55.6 (11.5 to 70.1)
< 0.001
Cardiac death
0/71
2/99 (2%)
0.511
Noncardiac death
4/71 (6%)
1/99 (1%)
0.162
All death
4/71 (6%)
3/99 (3%)
0.453
MI event
0/71
2/99 (2%)
0.511
PCI event
1/71
1/99
Redo CABG
0/71
0/99
Stroke event
0/71
0/99
Sternal infection
0/71
0/99
Follow up time (mo)
5 Years Survival of
Off Pump VS On Pump
0.00
Survival Probability
0.25
0.50
0.75
1.00
Kaplan-Meier Estimates: On Pump vs. Off Pump
Off Pump
96%
On Pump
95%
170
164
0
20
150
65
40
60
Time since operation (months)
13
80
Conclusion
Our studies have shown that the “Off Pump”
CABG in our patient population is associated
with lower incidence of post operative AF, lesser
myocardial injury, lesser bleeding and blood
transfusion with comparable excellent 5 years
survival.
Off pump may be more benefit than conventional
CABG in the patients who has higher risk and
poor reserve.
“Dedicated to our Rama-Off Pump Team”