Off-Pump Coronary Artery Bypass Surgery Is Associated With Worse Arterial and Saphenous Vein Graft Patency and Less Effective Revascularization Results From the Veterans Affairs Randomized On/Off Bypass (ROOBY) Trial

• Published in: Circulation (New York, N.Y.) Vol. 125; no. 23; pp. 2827 - 2835
• Main Authors: Hattler, Brack, Messenger, John C., Shroyer, A. Laurie, Collins, Joseph F., Haugen, Scott J., Garcia, Joel A., Baltz, Janet H., Cleveland, Joseph C., Novitzky, Dimitri, Grover, Frederick L.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 12.06.2012
• Subjects: Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Coronary Angiography; Coronary Artery Bypass, Off-Pump - adverse effects; Coronary Artery Bypass, Off-Pump - methods; Coronary Disease - diagnostic imaging; Coronary Disease - surgery; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - etiology; Graft Survival - physiology; Humans; Male; Medical sciences; Middle Aged; Myocardial Revascularization; Radial Artery - physiology; Radial Artery - transplantation; Saphenous Vein - physiology; Saphenous Vein - transplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular Patency - physiology; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Veterans; Bypass; Saphenous vein; Surgery; Cardiovascular disease; Veteran; coronary artery bypass; Coronary heart disease; coronary artery bypass, off-pump; Revascularization
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.111.069260

The Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) trial compared clinical and angiographic outcomes in off-pump versus on-pump coronary artery bypass graft (CABG) surgery to ascertain the relative efficacy of the 2 techniques. From February 2002 to May 2007, the ROOBY trial randomized 2203 patients to off-pump versus on-pump CABG. Follow-up angiography was obtained in 685 off-pump (62%) and 685 on-pump (62%) patients. Angiograms were analyzed (blinded to treatment) for FitzGibbon classification (A=widely patent, B=flow limited, O=occluded) and effective revascularization. Effective revascularization was defined as follows: All 3 major coronary territories with significant disease were revascularized by a FitzGibbon A-quality graft to the major diseased artery, and there were no new postanastomotic lesions. Off-pump CABG resulted in lower FitzGibbon A patency rates than on-pump CABG for arterial conduits (85.8% versus 91.4%; P=0.003) and saphenous vein grafts (72.7% versus 80.4%; P<0.001). Fewer off-pump patients were effectively revascularized (50.1% versus 63.9% on-pump; P<0.001). Within each major coronary territory, effective revascularization was worse off pump than on pump (all P≤0.001). The 1-year adverse cardiac event rate was 16.4% in patients with ineffective revascularization versus 5.9% in patients with effective revascularization (P<0.001). Off-pump CABG resulted in significantly lower FitzGibbon A patency for arterial and saphenous vein graft conduits and less effective revascularization than on-pump CABG. At 1 year, patients with less effective revascularization had higher adverse event rates. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00032630.