• Joon Bum Kim, Sung-Cheol Yun, Jae Wong Lim, Soo Kyung Hwang, Sung-Ho Jung, Hyun Song, Cheol Hyun Chung, Jae Won Lee, and Suk Jung Choo.
• Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
• J. Am. Coll. Cardiol. 2014 Jun 3; 63 (21): 2280-8.

ObjectivesThis study sought to compare long-term survival after off- and on-pump coronary artery bypass grafting (CABG).BackgroundAlthough several large-scale clinical trials have compared the surgical outcomes between off- and on-pump CABG, the long-term survival has not been compared between the 2 surgical strategies in a reasonably sized cohort.MethodsWe evaluated long-term survival data in 5,203 patients (age 62.9 ± 9.1 years, 1,340 females) who underwent elective isolated CABG (off-pump: n = 2,333; on-pump: n = 2,870) from 1989 through 2012. Vital statuses were validated using the Korean National Registry of Vital Statistics. Long-term survival was compared with the use of propensity scores and inverse probability weighting to adjust selection bias.ResultsPatients undergoing on-pump CABG had a higher number of distal anastomoses than those undergoing off-pump CABG (3.7 ± 1.2 vs. 3.0 ± 1.1; p < 0.001). Survival data were complete in 5,167 patients (99.3%), with a median follow-up duration of 6.4 years (interquartile range: 3.7 to 10.5 years; maximum 23.1 years). During follow-up, 1,181 patients (22.7%) died. After adjustment, both groups of patients showed a similar risk of death at 30 days (odds ratio: 0.70; 95% confidence interval [CI]: 0.35 to 1.40; p = 0.31) and up to 1 year (hazard ratio [HR]: 1.11; 95% CI: 0.74 to 1.65; p = 0.62). For overall mortality, however, patients undergoing off-pump CABG were at a significantly higher risk of death (HR: 1.43; 95% CI: 1.19 to 1.71; p < 0.0001) compared with those undergoing on-pump CABG. In subgroup analyses, on-pump CABG conferred survival benefits in most demographic, clinical, and anatomic subgroups compared with off-pump CABG.ConclusionsIn patients undergoing elective isolated CABG, on-pump strategy conferred a long-term survival advantage compared with off-pump strategy.Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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