Published online before print November 22, 2004, doi: 10.1161/01.CIR.0000148139.79580.36
(Circulation. 2004;110:3418-3423.)
© 2004 American Heart Association, Inc.
Coronary Heart Disease |
One-Year Coronary Bypass Graft Patency
A Randomized Comparison Between Off-Pump and On-Pump Surgery Angiographic Results of the PRAGUE-4 Trial
From Cardiocenter, 3rd Medical School, Charles University, Hospital Kralovske Vinohrady, Prague, Czech Republic.
Correspondence to Petr Widimsky, MD, DrSc, FESC, Cardiocenter, University Hospital Vinohrady, 
robárova 50, 100 34 Prague 10, Czech Republic. E-mail widim{at}fnkv.cz
Received December 29, 2003; de novo received April 21, 2004; revision received June 21, 2004; accepted July 21, 2004.
Background— Off-pump coronary bypass surgery has become a widely used technique during recent years. However, limited data are available with regard to 1-year patency of bypass grafts implanted on the beating heart in unselected consecutive bypass surgery candidates. The aim of this study was to compare 1-year angiographic patency of bypass grafts done on the beating heart (off pump) with those done classically (on pump).
Methods and Results— The PRAGUE-4 trial randomized 400 consecutive nonselected cardiac surgery candidates into group A (on pump; n=192) and group B (off pump; n=208). One-year follow-up coronary angiography was done in 255 patients. The arterial graft patency after 1 year was 91% in both groups. Saphenous graft patency was 59% (on pump) versus 49% (off pump; P=NS). Saphenous graft patency per patient was lower in the off-pump group: 0.7 patent anastomosis per patient versus 1.1 patent anastomosis in the on-pump group (P<0.01). There were 46% on-pump patients with all grafts patent versus 52% off-pump patients (P=NS). Grafts anastomosed distally to collateralized chronic total occlusions of native coronary arteries remained patent in 100% on the left anterior descending artery compared with 23% on other arteries (P<0.0001).
Conclusions— The patency of arterial coronary bypass grafts done on the beating heart is excellent and equal to grafts done on pump. The off-pump procedure in the unselected patient population results in fewer patent saphenous grafts per patient.
Key Words: angiography • coronary artery bypass • heart • surgery
Related Article:
Circulation 2004 110: 3399.
This article has been cited by other articles:
 |
|
 |
|
  C. H. Moller, L. Penninga, J. Wetterslev, D. A. Steinbruchel, and C. Gluud Clinical outcomes in randomized trials of off- vs. on-pump coronary artery bypass surgery: systematic review with meta-analyses and trial sequential analyses Eur. Heart J., July 15, 2008; (2008) ehn335v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Alamanni, L. Dainese, M. Naliato, S. Gregu, M. Agrifoglio, G. L. Polvani, P. Biglioli, A. Parolari, and for the Monzino OPCAB Investigators On- and off-pump coronary surgery and perioperative myocardial infarction: an issue between incomplete and extensive revascularization. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 118 - 126. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. G Raja and G. D Dreyfus Current Status of Off-pump Coronary Artery Bypass Surgery Asian Cardiovasc Thorac Ann, April 1, 2008; 16(2): 164 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Balacumaraswami, Y. Abu-Omar, J. Selvanayagam, D. Pigott, and D. P. Taggart The effects of on-pump and off-pump coronary artery bypass grafting on intraoperative graft flow in arterial and venous conduits defined by a flow/pressure ratio J. Thorac. Cardiovasc. Surg., March 1, 2008; 135(3): 533 - 539. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Vanek, M. Jares, J. Snircova, and M. Maly Fibrinolysis in coronary artery surgery: detection by thromboelastography Interactive CardioVascular and Thoracic Surgery, December 1, 2007; 6(6): 700 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. R. Cho, D. S. Jeong, and K.-B. Kim Influence of vein graft use on postoperative 1-year results after off-pump coronary artery bypass surgery Eur. J. Cardiothorac. Surg., November 1, 2007; 32(5): 718 - 723. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Paparella, G. Cappabianca, P. Malvindi, A. Paramythiotis, A. Galeone, N. Veneziani, C. Fondacone, and L. de Luca Tupputi Schinosa Myocardial injury after off-pump coronary artery bypass grafting operation Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 481 - 487. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Balacumaraswami and D. P. Taggart Intraoperative Imaging Techniques to Assess Coronary Artery Bypass Graft Patency Ann. Thorac. Surg., June 1, 2007; 83(6): 2251 - 2257. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. van Dijk, M. Spoor, R. Hijman, H. M. Nathoe, C. Borst, E. W. L. Jansen, D. E. Grobbee, P. P. T. de Jaegere, C. J. Kalkman, and for the Octopus Study Group Cognitive and Cardiac Outcomes 5 Years After Off-Pump vs On-Pump Coronary Artery Bypass Graft Surgery JAMA, February 21, 2007; 297(7): 701 - 708. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Murphy, T. W. Johnson, M. H. Chamberlain, S. I. Rizvi, M. Wyatt, S. J. George, G. D. Angelini, K. R. Karsch, M. Oberhoff, and A. C. Newby Short- and long-term effects of cytochalasin D, paclitaxel and rapamycin on wall thickening in experimental porcine vein grafts Cardiovasc Res, February 1, 2007; 73(3): 607 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Takagi, T. Tanabashi, N. Kawai, T. Kato, and T. Umemoto Off-pump coronary artery bypass sacrifices graft patency: Meta-analysis of randomized trials J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): e2 - e3. [Full Text] [PDF]
|
|
|
|
|
|
H. Takagi, M. Sugimoto, T. Kato, Y. Matsuno, and T. Umemoto Does Off-Pump Coronary Artery Bypass Graft Surgery Increase Risk of Graft Occlusion? Ann. Thorac. Surg., August 1, 2006; 82(2): 769 - 770. [Full Text] [PDF]
|
|
|
|
 |
|
 I. El-Hamamsy, R. Cartier, P. Demers, D. Bouchard, and M. Pellerin Long-Term Results After Systematic Off-Pump Coronary Artery Bypass Graft Surgery in 1000 Consecutive Patients Circulation, July 4, 2006; 114(1_suppl): I-486 - I-491. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G W Mikhail Coronary revascularisation in women Heart, May 1, 2006; 92(suppl_3): iii19 - iii23. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Alexander, R. A. Harrington, T. B. Ferguson, E. D. Peterson, C. M. Gibson, N. T. Kouchoukos, and for the PREVENT IV Investigators Efficacy and Safety of Edifoligide--Reply JAMA, April 5, 2006; 295(13): 1514 - 1515. [Full Text] [PDF]
|
|
|
|
|
|
D. Paparella, A. Galeone, M. T. Venneri, M. Coviello, G. Scrascia, N. Marraudino, M. Quaranta, L. de Luca Tupputi Schinosa, and S. J. Brister Activation of the coagulation system during coronary artery bypass grafting: Comparison between on-pump and off-pump techniques J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 290 - 297. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Poston, J. Gu, J. M. Brown, J. S. Gammie, C. White, L. Nie, R. N. Pierson III, and B. P. Griffith Endothelial injury and acquired aspirin resistance as promoters of regional thrombin formation and early vein graft failure after coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 122 - 130. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Parolari, F. Alamanni, G. Polvani, M. Agrifoglio, Y. B. Chen, S. Kassem, F. Veglia, E. Tremoli, and P. Biglioli Meta-Analysis of Randomized Trials Comparing Off-Pump With On-Pump Coronary Artery Bypass Graft Patency Ann. Thorac. Surg., December 1, 2005; 80(6): 2121 - 2125. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. R. Conti and G. C. Hunter Gene Therapy and Vein Graft Patency in Coronary Artery Bypass Graft Surgery JAMA, November 16, 2005; 294(19): 2495 - 2497. [Full Text] [PDF]
|
|
|
|
|
|
PREVENT IV Investigators Efficacy and Safety of Edifoligide, an E2F Transcription Factor Decoy, for Prevention of Vein Graft Failure Following Coronary Artery Bypass Graft Surgery: PREVENT IV: A Randomized Controlled Trial JAMA, November 16, 2005; 294(19): 2446 - 2454. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H. Jones The Year in Cardiovascular Surgery J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1517 - 1528. [Full Text] [PDF]
|
|
|
|
|
|
PREVENT IV Investigators Efficacy and Safety of Edifoligide, an E2F Transcription Factor Decoy, for Prevention of Vein Graft Failure Following Coronary Artery Bypass Graft Surgery: PREVENT IV: A Randomized Controlled Trial JAMA, November 16, 2005; 294(19): 2446 - 2454. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. R. Conti and G. C. Hunter Gene Therapy and Vein Graft Patency in Coronary Artery Bypass Graft Surgery JAMA, November 16, 2005; 294(19): 2495 - 2497. [Full Text] [PDF]
|
|