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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. 

Keywords

On-pump coronary artery bypass; Off-pump coronary artery bypass; Re-intervention; Late mortality; Graft durability  

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