Comparison between off-pump versus on-pump beating heart coronary artery bypass grafting

Background. Although coronary artery bypass grafting (CABG) is performed via three different techniques, conventional, on-pump beating heart CABG (ONBHCAB), or off-pump CABG (OPCAB), data is limited to compare ONBHCAB versus OPCAB. Methods. We retrospectively investigated postoperative cardiac biomarkers, creatine kinase-MB (CK-MB) and Troponin I (cTnI), early and late outcomes in 806 patients undergoing isolated ONBHCAB or OPCAB between February 2008 and September 2022. To eliminate the bias between different groups, propensity score matching was conducted to validate the findings. Results. After matching, the number of each study group totaled 270 patients. In both complete and matched cohorts, early outcomes, including morbidities and mortalities, were similar. However, cTnI and CK-MB levels were significantly higher after ONBHCAB than after OPCAB with the median peak cTnI of 9.85 ng/mL versus 4.60 ng/mL and the median peak CK-MB of 48.45 ng/mL versus 17.10 ng/mL in the matched cohort, which were quite low below the threshold for values defining perioperative myocardial infarction. At follow-up of 73 ± 45 months, the overall actuarial survival rates were similar between the ONBHCAB and OPCAB patients (86 % versus 87 % at 5 years and 64 % versus 68 % at 10 years, respectively, in the matched cohort). Conclusions. ONBHCAB may be a comparable alternative to OPCAB with similar early and late outcomes, despite higher elevation of postoperative cardiac biomarkers. ONBHCAB provides more efficient hemodynamic support, providing a better surgical visual field, than OPCAB while reducing the risk of incomplete revascularization.