Off-pump coronary artery bypass graft surgery may lead to lower incidence rates for atrial fibrillation, stroke, and perioperative infection than on-pump surgery, according to an article in the November issue of Stroke.

The new analysis of trial data was conducted by the US Agency for Healthcare Research and Quality (AHRQ) and led by Artyom Sedrakyan, MD, PhD, a cardiothoracic surgeon.

"These findings represent a significant piece of new information regarding a common surgery,” said AHRQ Director Carolyn M. Clancy, MD. “Evidence emerging from this report will give physicians and, ultimately, patients a great deal more information upon which they can base decisions about care.”

The report analyzed data from 41 randomized clinical trials that included 3,996 patients whose procedures were done after 1999; it is the first to document benefits of off-pump procedures compared with on-pump procedures. Specifically, off-pump procedures prevented approximately 10 strokes per 1,000 procedures, a 50-percent reduction in risk. In addition, off-pump procedures were associated with prevention of 80 cases of atrial fibrillation per 1,000 procedures, a 30-percent reduction risk. Finally, off-pump procedures prevented 40 infections per 1,000 procedures, a 48-percent reduction in wound infection.

The study also found that off-pump surgery often involved fewer grafts to bypass coronary lesions compared with traditional, on-pump surgery. Fewer grafts could lead to repeat interventions, such as repeat angioplasties or surgeries, and have unknown long-term effects.

However, researchers found evidence that the difference between off-pump and on-pump surgery in the number of bypass grafts used seemed to be small in studies in which more procedures were performed. This indicates a relationship between the volume of procedures and their outcome. In other words, off-pump procedures are more successfully performed at facilities that perform many of them.

Sedrakyan cautioned that the report provides limited evidence of off-pump procedure benefits, and that traditional procedures may still be warranted in many cases. “Off-pump CABG carries its own risks, and requires substantial training to learn and perform comfortably,” he said. “We look forward to more research on long-term outcomes and in settings outside trials to learn more about this important surgery.”