Cardiac surgeons prove decreased mortality with off-pump coronary artery bypass grafting

(Landmark study on lowering the risk of CABG in high-risk patients reported at the American Association for Thoracic Surgery meeting)

NYU Medical Center’s cardiac surgeons Eugene Grossi, MD, and Aubrey Galloway, MD, announced new study findings demonstrating significantly lowered mortality, stroke, and overall risk of complications using off-pump coronary artery by-pass grafting (OPCAB) in high-risk patients. The findings were presented today during the Adult Cardiac Surgery Scientific Session at the 83rd annual meeting of the American Association of Thoracic Surgeons (AATS) meeting in Boston, MA.

One of the most exciting, and albeit controversial, innovations in coronary artery bypass grafting (CABG) over the past five years has been the introduction of “beating heart” or “off-pump” surgery. During this approach certain areas of the heart are immobilized with cardiac stabilizers allowing the heart to continue beating during surgery instead of placing the patient on conventional cardiopulmonary bypass (CPB).

NYU’s cardiac surgical research team conducted this study over 10 years to access the efficacy of off-pump coronary artery bypass versus conventional techniques in high-risk patients with severe aortic atherosclerotic disease.

According to Galloway, Director of Cardiac Surgical Research and co-investigator, “This is a very positive study for cardiac surgeons and their patients. Today, we are being asked to treat more patients who are older and have more co-existing conditions than patients a few years ago. Cardiac surgery has evolved to address this changing trend, and coronary artery bypass can now be done in a less traumatic way, minimizing risk in these older, more severely diseased patients.”

Outcomes data were collected on 5,737 CABG patients, identifying 913 patients as high-risk from advanced aortic atherosclerosis, using intraoperative transesophageal echocardiography. Of the high-risk patients, 235 underwent OPCAB, and a propensity case match analysis was conducted comparing data on 229 high-risk OPCAB patients with 229 high-risk conventional CPB patients. Results demonstrated a lower hospital mortality (6.5% vs 11.4%), lower risk of stroke (1.6% vs 5.7%) and better freedom from all complications (92.2% vs 80. 0%) in the OPCAB patients. Hospital stay was also 2 days shorter in the OPCAB patients.

“Despite recent advances in angioplasty and stenting, coronary artery bypass surgery is still necessary for hundreds of thousands of patients a year and this study demonstrates an approach for making the surgery safer in elderly, high-risk patients,” says Grossi, principal investigator of the study.

NYU’s cardiac surgical program is internationally recognized for both clinical care and innovative research. This study shows the risk-lowering benefits of newer techniques and evolving technologies in patients requiring coronary artery bypass grafting.