Long‐Term Survival After Off‐Pump Coronary Artery Bypass Grafting in a High‐Volume Centre

Introduction:

There is controversy in the literature regarding the long-term outcomes of off-pump coronary artery bypass (OPCAB) compared to conventional on-pump coronary artery bypass (ONCAB) grafting.

Methods:

We retrospectively reviewed prospectively collected data on first-time elective or urgent isolated CABG patients (1996–2023). The primary objective was to compare long-term survival between patients who underwent OPCAB or ONCAB after inverse probability of treatment weighting (IPTW). Long-term survival was then categorised into a learning phase (1996–2002), a consolidation phase (2003–2012) and a specialist phase (2013–2023) of the OPCAB technique.

Results:

A total of 16,941 patients (46.75% OPCAB), with a median age of 66.8 years, were included, of whom 82.32% were male. The use of OPCAB increased until 2008 (78.11%), after which it steadily decreased to 35.52% in 2022. After IPTW, the OPCAB cohort, when compared with ONCAB, had a lower incidence of cerebrovascular accidents (0.51% vs. 1.09%, p < 0.0001). In addition, the OPCAB group were less likely to return to theatre (RTT) overall (3.46% vs. 4.08%, p = 0.0028), with post hoc testing showing they were less likely to RTT for bleeding or tamponade (2.27% vs. 3.14%, p < 0.0001) but more likely to RTT for graft revision (0.17% vs. 0.09%, p = 0.0316). There was no difference in in-hospital mortality between the groups (log-rank p = 0.70). During the learning phase, the OPCAB group had a lower survival rate than the OPCAB group (log-rank p = 0.018). However, in the specialist phase, OPCAB patients had a higher survival probability than ONCAB patients (log-rank p = 0.016).

Conclusion:

OPCAB, compared with ONCAB, was associated with a lower incidence of CVA. Overall, long-term mortality was similar in the two groups. OPCAB, after the initial learning curve, was associated with higher long-term survival compared to ONCAB grafting when performed by experienced surgeons.