Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials.

摘要: Summary Background Although no randomised controlled trial has assessed the midterm effects of coronary-artery bypass surgery on beating heart, this technique is being used in more and patients. We did two trials to compare short-term morbidity associated with off-pump on-pump myocardial revascularisation. Our aim was pool results assess outcomes. Methods From March, 1997, November, 1999, we randomly allocated 200 patients 201 coronary surgery. In Beating Heart Against Cardioplegic Arrest Study (BHACAS) 1, excluded who had infarction past month or required grafting circumflex artery distal first obtuse marginal branch. BHACAS 2, included such Primary outcomes were all-cause mortality cardiac-related events at follow-up (1–3 years). Analysis by intention treat. Findings Analyses combined data from both showed following risk differences compared surgery: atrial fibrillation −25% (95% CI −33% −16%); chest infection −12% (−19% −5%); inotropic requirement −18% (−25% −10%); transfusion red blood cells −31% (−41 −21); hospital stay longer than 7 days −13% (−21 −5). Mean 25·0 months (SD 9·1) for 1 13·7 (5·5) 2. Four (2%) groups died any cause, seven (3%) group (hazard ratio 0·57, 95% 0·17–1·96). 33 (17%) a event, 42 (21%) (0·78, 0·49–1·22). Interpretation Off-pump significantly lowers in-hospital without compromising outcome 1–3 years after conventional