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
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