Off-Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs’ Use and Outcomes

Abstract

BACKGROUND: Coronary artery bypass can be performed off pump (OPCAB) without cardiopulmonary bypass. However, trends over time for OPCAB versus on-pump (ONCAB) use and long-term outcome has not been reported, nor has their long-term outcome been compared. METHODS AND RESULTS: We queried the national Veterans Affairs database (2005– 2019) to identify isolated coronary artery bypass procedures. Procedures were classified as OPCAB on ONCAB using the as-treated basis. Trend analyses were performed to evaluate longitudinal changes in the preference for OPCAB. The median follow-up period was 6.6 (3.5–10) years. An inverse probability weighted Cox model was used to compare all-cause mortality between OPCAB and ONCAB. From 47 685 patients, 6759 (age 64±8 years) received OPCAB (14%). OPCAB usage declined from 16% (2005– 2009) to 8% (2015– 2019). Patients with triple vessel disease who received OPCAB received a lower mean number of grafts (2.8±0.8 versus 3.2±0.8; P<0.01). The ONCAB 5-, 10-, and 15-year survival rates were 82.9% (82.5– 83.3), 60.4% (59.8– 61.1), and 37.2% (36.1– 38.4); corre-spondingly, OPCAB rates were 80.7% (79.7– 81.7), 57.4% (56– 58.7), and 34.1% (31.7– 36.6) (P<0.01). OPCAB was associated with increased risk-adjusted all-cause mortality (hazard ratio, 1.15 [1.13–1.18]; P<0.01) and myocardial infarction (incident rate ratio, 1.16 [1.05–1.28]; P<0.01). CONCLUSIONS: Over 15 years, OPCAB use declined considerably in Veterans Affairs medical centers. In Veterans Affairs hos-pitals, late all-cause mortality and myocardial infarction rates were higher in the OPCAB cohort.