Tuesday, July 30, 2013


I have always thought that CABG must be better than PCI in terms of completeness of revascularisation and also MACCE events and mortality, cardiac and non cardiac. The procedure of doing CABG is ( in my opinion ) fundamentally wrong as operating on a beating heart always have that element of luck, to try and put down a good graft with great technical precision. Those graft must last and be near perfect. How one can say that that is possible, with a straight face beats me. The heat is beating and even with the best of stabilisers and clamps, this must at best be a chance process. Of course there is a cost advantage with off pump.

Well, Dr Harold Lazaar from the Boston Medical Center published his research into the ROOBY trial, SMART trial and CORONARY trial. These were all trials comparing off pump Vs the conventional CABG. He found that there was no improvement in MACCE and Death at 30 days, but there was a difference in Cardiac mortality, being higher in patients given off pump CABG ( OP CAB ).
In fact, he concluded that maybe Off Pump should be abandoned in favour of conventional CABG.

Dr Robin Cohen ( University of Souther California ) argued that it was too early to speak of abandoning Off Pump, but he has also reduced his pff pump rate from nearly 90% of his CABG to the current 10% of CABG.

Looks like the reality is setting in. OP CAB has shortcomings, mainly from incomplete revascularsation, as we expected. It did not offer any advantage over conventional CABG We now know, mainly from the CORONARY trial, that neuro-psychiatry changes were as frequent wth on pump as with off pump. Even there there is no advantage.

I do hope that those who are doing and advocating off pump CABG will take note of the recent findings and think in the best interest of the patient.

Shall we abandon off pump CABG, perhaps not yet, but the thunder is certainly getting louder.

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