Monday 9 May 2011

ANOTHER NAIL IN THE OPCAB COFFIN



Three-year follow-up in a subset of high-risk patients randomly assigned to off-pump versus on-pump coronary artery bypass surgery: the Best Bypass Surgery Trial -- Møller et al. 97 (11): 907 -- Heart

This study provides some more evidence for the non-inferiority and probably superiority of on pump coronary surgery when to compared to off pump CABG in higher risk patients.
Although I used to be an advocate for OPCAB and believed that the methodology may yield superior clinical results in higher risk patients, I have always accepted the need for a properly randomised clinical trial. This study, withdrawal of funding for the CRISP trial by the MRC, to a lesser extent the ROOBY trial, and personal experience have persuaded me to restrict OPCAB to the following situations - patients with disease which is ONLY present in the LAD and/or PDA - (it is easier and quicker without bypass) and patients with diseased/porcelain aorta (for obvious reasons). If a patient is too high risk for on pump CAB, he is high risk for all forms of CABG - period!

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