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A Comparison of On-Pump and Off-Pump Coronary Bypass Surgery in Low-Risk Patients. - A Comparison of On-Pump and Off-Pump Coronary Bypass Surgery in Low-Risk Patients.
Description:
The goal of this study was to dettermine if there a difference in outcomes and cost-effectiveness (cost differences per quality-adjusted life) between coronary bypass surgery without cardiopulmonary bypass (“off pump”) and that involving the use of cardiopulmonary bypass (“on pump”).
Study Design
Study Design:
Patients Enrolled: 281
Drug/Procedures Used:
Patients with predominantly single- or double-vessel coronary disease were randomized to receive on-pump surgery (n=139) or off-pump surgery (n=142). One-year cardiac outcomes and cost effectiveness were determined after surgery for the two approaches to coronary revascularization.
Principal Findings:
The rate of freedom from death, stroke, myocardial infarction, and coronary reintervention at one year was similar in the on-pump and the off-pump group (90.6% versus 88.0%, respectively; absolute difference, 2.6 percent; 95 percent confidence interval, -4.6 to +9.8). The patency of grafts was also similar after on-pump and off-pump surgery (93% versus 91%; absolute difference, 2.0 percent; 95 percent confidence interval, -6.5 to +10.4). The direct costs per patient were $1,839 (14%) more for on-pump surgery than that for off-pump surgery ($14,908 versus. $13,069). The increase in quality-adjusted years of life was 0.83 for on-pump compared with 0.82 for off-pump surgery (difference, 0.01 year; 95 percent confidence interval, -0.03 to +0.04). Off-pump surgery was more cost effective than on-pump surgery in 95 percent of standard bootstrap estimates.
Interpretation:
Among low-risk patients, cardiac outcomes at one year were similar in patients who underwent on-pump bypass surgery and those who underwent off-pump surgery, off-pump surgery was more cost effective. While these initial results are encouraging, more experience is needed in larger numbers of patients before recommending the ubiquitous use of off-pump surgery over on-pump surgery. Furthermore, these results should not be extrapolated to patients at high-risk for coronary revascularization (those requiring emergent coronary bypass or concomittant major surgery, those with recent myocardial infarction, or those with three vessel disease or severe left ventricular dysfunction) as these patients were excluded from these trial.
References:
Nathoe HM, van Dijk D, Jansen EWL, et al. A Comparison of On-Pump and Off-Pump Coronary Bypass Surgery in Low-Risk Patients. N Engl J Med 2003;348:394-402.
Presented at the European Society of Cardiology, Vienna, Austria, September 2003.
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