Abstract
Background: While favorable short-term outcomes of off pump coronary artery bypass grafting (OPCAB) has been recognized, concerns regarding long-term outcomes including late survival, re-intervention, recurrent angina, and graft durability persist.
Objective: In this review, we utilized randomized controlled trials (RCTs) that reported long-term outcomes (5-20 years) comparing on-pump coronary artery bypass grafting (ONCAB) vs OPCAB.
Methods: Key studies were reviewed for long-term outcomes. We only included RCTs data that reported a follow-up of ≥ 5 year. Included studies were CORONARY trial (5-year), SMART trial (6.8-7.5 year), ROOBY-FS and MASS III trials (10-year), and OCTOPUS trial (20 years). Outcomes investigated include late mortality, coronary reinterventions, recurrence of angina, myocardial infarction or ischemia, and graft durability.
Results: Evidence derived from the data investigated demonstrated that late survival was consistently equivalent between ONCAB and OPCAB methods, and the 20-year results from the OCTOPUS trial confirmed this equivalence. Studies that involved highly experienced OPCAB surgeons (MASS III and SMART) demonstrated comparable rates of coronary re-interventions, recurrence of angina, and myocardial infarction indicating similar graft patency. While a trial (ROOBY-FS) conducted by varied surgical experience showed higher rates of coronary reintervention and inferior graft durability in the OPCAB cohort.
Conclusion: Both strategies, ONCAB and OPCAB offer comparable and excellent long-term outcomes especially in the centers of high OPCAB surgical expertise. The choice between the surgical methods should be individualized according to the patient comorbidities and the surgeon experience.
