# Do patients with ischaemic cardiomyopathy benefit from off-pump coronary bypass surgery? (From the KROK registry)

## TL;DR

This study compares off-pump and on-pump heart bypass surgery in patients with ischaemic cardiomyopathy, finding short-term benefits for off-pump but better long-term survival with on-pump.

## Contribution

The study provides new evidence on the comparative effectiveness of off-pump versus on-pump surgery in ischaemic cardiomyopathy patients using a large national registry.

## Key findings

- Off-pump surgery was linked to lower 30-day mortality and fewer complications.
- On-pump surgery showed a modest but significant long-term survival advantage at 10 years.
- Short-term benefits of off-pump do not translate to improved long-term survival.

## Abstract

This study aimed to compare perioperative outcomes and long-term mortality between off-pump coronary artery bypass grafting and on-pump coronary artery bypass grafting in patients with ischaemic cardiomyopathy who had a left ventricle ejection fraction of ≤35%.

A retrospective cohort analysis was conducted using data from the Polish National Registry of Cardiac Surgery Procedures database, encompassing patients who underwent isolated coronary artery bypass grafting in Poland between 2012 and 2022. Patients were divided into two groups: on-pump and off-pump. Propensity score matching was used to balance the groups. The primary outcome was long-term all-cause mortality following surgical revascularization.

A total of 9920 patients were included, with 3116 patients in each group after propensity score matching. The median follow-up period was 4 years. The off-pump group was associated with a lower 30-day mortality rate (6.4% vs 9.1%, P = 0.002) and fewer perioperative complications. However, long-term survival analysis revealed a modest but statistically significant advantage for on-pump group at the 10-year follow-up (P = 0.047).

Off-pump provides short-term benefits, including reduced early mortality and fewer complications compared to on-pump technique. However, these advantages do not translate into improved long-term survival, where on-pump demonstrates a slight benefit. The choice between off-pump and on-pump technique should be individualized based on patient-specific factors and surgical expertise.

Ischaemic cardiomyopathy (ICM) manifests as reduced left ventricle ejection fraction (LVEF) due to acute or acute on chronic coronary artery disease, posing a significant global health challenge [1].