1. 5 Years Results of Off-Pump VS On-Pump CABG 5 Years Results of Off-Pump VS On-Pump CABG Prospective Non-randomized Comparative Study Piya Cherntanomwong*, Panuwat Lertsithichai*, Somchai Viengteerawat**, Suchart Chaiyaroj*. *Cardiothoracic surgery unit, Department of surgery **Department of Anesthesiology Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok,Thailand.

2. Objectives To review experience of off pump and on pump CABG at our institute to compare early and long- term results and to determine the differences of OPCAB and conventional CABG.

3. Prospective, Non-randomized Study (Approved by Ethic Committee, Protocol ID : 06-51-03) Baseline characteristics were compared Primary Endpoint Secondary Endpoint Follow up to December 2008

4. The outcomes Primary endpoints Operative mortality Bleeding and Blood transfusion Myocardial injury Post operative AF Other post operative complications Secondary endpoints Late death MI Stroke PCI Redo CABG Sternal wound infection

5. Operative technique for Off Pump CABG Octopus tissue stabilizer Starfish heart positioner (Medtronic Inc., Minneapolis, MN) The intracoronary shunt

6. Data Analysis Continuous data were compared between two independent groups using unpaired t-test or Wilcoxon rank sum test as appropriate, and categorical data were compared between groups using the chi-square test. The long-term probability of survival was estimated using the Kaplan-Meier method. Cox proportional hazards models were used to test the significance of prognostic factors for long-term survival. All statistical analyses were performed using Stata version 9 (Stata Corp, College Station, TX, USA). Statistical significance was defined as a two-sided p-value of 0.05 or less.

7. Base-Line Characteristics of the Patients Off pumpOn pumpP-value Number pateints 170 cases99 cases71 cases Sex male79 ( 80% )55 ( 72% )0.16 ( NS ) female20 ( 20% )22 ( 28% ) ( NS ) Age60.873 + 8.4660.515 + 11.720.83 ( NS ) BW66.474 + 1.04666.907 + 1.3260.54 ( NS ) Previous HT98 ( 100 % )77 ( 99%) ( NS ) Previous DM32 ( 33% )36 ( 46%)0.08 ( NS ) Previous MI53 ( 55% )23 ( 29%)0.10 ( NS ) Previous CHF42 ( 43%)25 ( 32%)0.13 ( NS ) Previous COPD83 ( 85%)52 ( 67%)0.06 ( NS ) Previous CVA6 ( 6% )9 ( 11%)0.21 ( NS ) Previous Renal dysfunction44 ( 46%)21 ( 27%)0.15 ( NS ) Previous Renal failure01 (1.4%) ( NS ) Previous Peripheral vascular disease02 (2.8%) ( NS ) Previous AF5 ( 5%)3 ( 7%)0.32 ( NS ) LVEF42 + 8.843 + 120.56 ( NS ) Functional class3 + 12.7 + 0.90.06 ( NS ) No. Vessel bypass3.9 + 1.03.6 + 0.80.07 ( NS ) EuroSCORE (logistic)4.2%2.9%0.05 ( NS )

8. Off pumpOn pump P-value Record ICD mean 12 hr. median/range 145 cc. 100 ( 0 – 1360 ) cc. 201 cc. 140 ( 0 – 1160 ) cc. < 0.001 PRC mean median/range 3. u 2 ( 0 – 6 ) u 4. u 2 ( 1 – 13 ) u 0.006 LPPC mean median/range 1. u 0 ( 0 – 4 ) u 6. u 0 ( 0 – 8 ) u 0.001 FFP mean median/range 0.5 u 0 ( 0 – 5 ) u 3. u ( 0 – 10 ) u 0.001 Results of using blood transfusion and bleeding

9. The results of using blood transfusion (p < 0.05)

10. Average serum CKMB plotted against time after operation for on-pump versus off-pump CABG

11. Complication Off-pumpOn-pumpP-value Postoperative AF10 ( 10% )19 ( 24% )0.013 Postoperative Re-operation1 (1%)1 (1.4%)NS Postoperative MI00NS Postoperative CVA1 (1%)0NS Postoperative Renal Failure02 (2.8%)NS Postoperative Respiratory Failure 02 (2.8%)NS Postoperative Sternum infection1 (1%)1 (1.4%)NS Postoperative Sepsis00NS Mortality1 (1%)1 (1.4%)NS Results of Postoperative Complications

12. Results of 5 years outcomes On pump (n = 71)Off pump (n = 99)p-value Follow up time (mo) Mean (SD)58.2 (15.6)53.8 (11.0)0.032 Median (range)63.7 (13.4 to 73.8)55.6 (11.5 to 70.1)< 0.001 Cardiac death0/712/99 (2%)0.511 Noncardiac death4/71 (6%)1/99 (1%)0.162 All death4/71 (6%)3/99 (3%)0.453 MI event0/712/99 (2%)0.511 PCI event1/711/99 Redo CABG0/710/99 Stroke event0/710/99 Sternal infection0/710/99

13. 5 Years Survival of Off Pump VS On Pump 0.00 0.25 0.50 0.75 1.00 Survival Probability 020406080 Time since operation (months) Kaplan-Meier Estimates: On Pump vs. Off Pump On Pump Off Pump 96% 95% 1701641506513

14. Conclusion Our studies have shown that the “Off Pump” CABG in our patient population is associated with lower incidence of post operative AF, lesser myocardial injury, lesser bleeding and blood transfusion with comparable excellent 5 years survival. Off pump may be more benefit than conventional CABG in the patients who has higher risk and poor reserve.

15. “Dedicated to our Rama-Off Pump Team”