• Petr Widimsky, Zbynek Straka, Petr Stros, Karel Jirasek, Jaroslav Dvorak, Jan Votava, Libor Lisa, Tomas Budesinsky, Miroslav Kolesar, Tomas Vanek, and Petr Brucek.
• Cardiocenter, 3rd Medical School, Charles University, Hospital Kralovske Vinohrady, Srobárova 50, 100 34 Prague 10, Czech Republic. widim@fnkv.cz
• Circulation. 2004 Nov 30;110(22):3418-23.

BackgroundOff-pump coronary bypass surgery has become a widely used technique during recent years. However, limited data are available with regard to 1-year patency of bypass grafts implanted on the beating heart in unselected consecutive bypass surgery candidates. The aim of this study was to compare 1-year angiographic patency of bypass grafts done on the beating heart (off pump) with those done classically (on pump).Methods And ResultsThe PRAGUE-4 trial randomized 400 consecutive nonselected cardiac surgery candidates into group A (on pump; n=192) and group B (off pump; n=208). One-year follow-up coronary angiography was done in 255 patients. The arterial graft patency after 1 year was 91% in both groups. Saphenous graft patency was 59% (on pump) versus 49% (off pump; P=NS). Saphenous graft patency per patient was lower in the off-pump group: 0.7 patent anastomosis per patient versus 1.1 patent anastomosis in the on-pump group (P<0.01). There were 46% on-pump patients with all grafts patent versus 52% off-pump patients (P=NS). Grafts anastomosed distally to collateralized chronic total occlusions of native coronary arteries remained patent in 100% on the left anterior descending artery compared with 23% on other arteries (P<0.0001).ConclusionsThe patency of arterial coronary bypass grafts done on the beating heart is excellent and equal to grafts done on pump. The off-pump procedure in the unselected patient population results in fewer patent saphenous grafts per patient.

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