Do patients with ischaemic cardiomyopathy benefit from off-pump coronary bypass surgery? (From the KROK registry).

Abstract

Objectives: This study aimed to compare perioperative outcomes and long-term mortality between off-pump coronary artery bypass grafting and on-pump coronary artery bypass grafting in patients with ischaemic cardiomyopathy who had a left ventricle ejection fraction of ≤35%.

Methods: A retrospective cohort analysis was conducted using data from the Polish National Registry of Cardiac Surgery Procedures database, encompassing patients who underwent isolated coronary artery bypass grafting in Poland between 2012 and 2022. Patients were divided into two groups: on-pump and off-pump. Propensity score matching was used to balance the groups. The primary outcome was long-term all-cause mortality following surgical revascularization.

Results: A total of 9920 patients were included, with 3116 patients in each group after propensity score matching. The median follow-up period was 4 years. The off-pump group was associated with a lower 30-day mortality rate (6.4% vs 9.1%, P = 0.002) and fewer perioperative complications. However, long-term survival analysis revealed a modest but statistically significant advantage for on-pump group at the 10-year follow-up (P = 0.047).

Conclusions: Off-pump provides short-term benefits, including reduced early mortality and fewer complications compared to on-pump technique. However, these advantages do not translate into improved long-term survival, where on-pump demonstrates a slight benefit. The choice between off-pump and on-pump technique should be individualized based on patient-specific factors and surgical expertise.