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Study shows on-pump bypass comparable to off-pump at year mark
Date:3/11/2013

es the need to insert a tube called a cannula into the aorta (the main artery distributing blood to the brain and body), cross-clamp the aorta, connect the patient to the heart-lung machine and stop and restart the heart.

The CORONARY study included patients from 79 centers in 19 countries who were scheduled to undergo CABG. Participants were randomly assigned to receive on-pump or off-pump CABG after a complete assessment to ensure they were appropriate for both techniques. In addition to the primary endpoint, researchers looked at the need for coronary revascularization between groups. This entails restoring blood flow to the heart through a repeat CABG or placement of a stent and indicates the initial CABG procedure was not successful. Again, results were similar between groups with 1.4 percent of patients in the off-pump group and 0.8 percent of patients in the on-pump group requiring this additional procedure.

The study also assessed the neurocognitive function and quality of life of patients in each group through the use of standardized scales.

"We found a transient improvement in neurocognitive function at hospital discharge among those receiving an off-pump bypass," Dr. Lamy said. "But at one year, our results are similar with both techniques."

According to Dr. Lamy, this transient difference in patients' neurocognitive functions came as a surprise to researchers, as smaller studies have shown evidence of short-term neurocognitive declines among patients receiving both types of bypass. Researchers found patients' quality of life to be similar after both on- and off-pump bypass.

The CORONARY study results differ from those emerging from another large trial that suggested improved outcomes at one year with on-pump surgery. According to Dr. Lamy, this discrepancy is likely related to surgeons' expertise in the two techniques, as well as the surgical risk of each patient.

"Compared to the other trial, our pat
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Contact: Beth Casteel
bcasteel@acc.org
240-328-4549
American College of Cardiology
Source:Eurekalert

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