Similar outcomes in older patients with on- or off-pump bypass

March 11, 2013, American College of Cardiology

Older patients did as well after undergoing coronary bypass surgery off-pump as they did with the more costly "on-pump" procedure using a heart-lung machine to circulate blood and oxygen through the body during surgery, according to research presented today at the American College of Cardiology's 62nd Annual Scientific Session.

This large, multicenter trial—the German Off-Pump Grafting in Elderly Patients, called GOPCABE—was the first to evaluate on-pump versus off-pump among patients aged 75 or older. The primary endpoint was individual patients' combined outcomes of death, stroke, heart attack, repeat revascularization or new renal replacement therapy within 30 days of surgery. Researchers found no significant difference in the primary endpoint between patients receiving the on-pump and off-pump procedures (8.2 vs. 7.8 percent, p = 0.74).

"Our study shows that can be performed in the with excellent results, and this is equally true for both techniques," said Anno Diegeler, MD, PhD, head of the department of cardiovascular surgery at the Heart Center Bad Neustadt in Germany and the study's lead investigator. "These findings suggest clinicians can select the lower cost off-pump procedure without risk to the patient."

, or CABG, is one of the most commonly performed operations in the U.S. and the world and consumes more resources in than any other procedure. In on-pump CABG, the patient's heart is stopped and blood is circulated through a heart-lung machine, where it is oxygenated and returned to the patient. In the off-pump technique, the surgeon uses a retractor to lift the still- and perform all coronary artery grafts. Off-pump CABG eliminates the need to insert a tube called a cannula into the aorta (the distributing blood to the brain and body), cross-clamp the aorta, connect the patient to the heart-lung machine, and stop and restart the heart.

Previous studies comparing the two techniques also found similar results for on-pump and off-pump CABG, but none of these studies focused exclusively on elderly patients. To address concerns that the elderly may not benefit equally from both techniques because of their higher risks, GOPCABE enrolled 2,539 patients aged 75 or older scheduled for elective, first-time CABG in 12 cardiovascular centers in Germany.

Patients were randomized to receive on-pump or off-pump CABG. Results for all components of the primary endpoint were similar between the groups at 30 days. Patients had no significant differences in rates of death (2.8 vs. 2.6 percent), stroke (2.7 vs. 2.2 percent), heart attack (1.7 vs. 1.5 percent), and new renal replacement therapy (3.1 vs. 2.4 percent), and a slim difference in repeat revascularization (0.4 vs. 1.3 percent). At 12 months, researchers again found no significant difference in the composite endpoint between on- and off-pump (14.0 vs. 13.1 percent, p = 0.483). Study results are important for surgeons who favor off-pump surgery, Dr. Diegeler said.

"For surgeons who prefer off-pump surgery, our study confirms that off-pump CABG is safe and the quality is equal to on-pump surgery for . At 12 months, we had a survival rate of 93 percent among our off-pump patients and 92 percent for on-pump," he said. He notes that the surgeon's level of experience is critical in assessing the two techniques.

According to Dr. Diegeler, the similar result from both techniques is beneficial to facilities and patients in developing countries, where the on-pump procedure may come at a higher cost since instruments used in off-pump CABG can be re-sterilized, but components of the machine used in on-pump cannot.

While this study provides support for the efficacy and safety of both CABG techniques in the elderly, Dr. Diegeler said further work is needed to look at CABG outcomes in other special populations, including deemed high-risk for surgery.

Explore further: Study shows on-pump bypass comparable to off-pump at year mark

Related Stories

Study shows on-pump bypass comparable to off-pump at year mark

March 11, 2013
Patients who underwent heart bypass surgery without a heart- lung machine did as well one year later as patients whose hearts were connected to a pump during surgery in a study presented today at the American College of Cardiology's ...

Largest study of on-pump and off-pump bypass proves both can be done safely

March 26, 2012
A large randomized trial comparing bypass surgery done with a heart-lung machine (on pump) and without it (off pump) found no differences in results between techniques overall but some clinically relevant differences, according ...

Open heart surgery for kidney disease patients

May 17, 2012
One type of open heart surgery is likely safer than the other for chronic kidney disease (CKD) patients, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

Beating heart surgery may increase risk to patients

March 14, 2012
Coronary artery bypass surgery performed whilst the heart is still beating may carry an increased likelihood of death, according to a systematic review by Cochrane researchers. The researchers suggest beating heart surgery ...

Recommended for you

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...

Place of residence linked to heart failure risk

January 9, 2018
Location. Location. Location.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.