16 Aug NEJM: On-Pump CABG Should Continue To Be Standard Surgical Treatment
MedicalResearch.com Interview with:
A. Laurie Shroyer, Ph.D., M.S.H.A.
WOC Health Science Officer
Research and Development Office (151)
Northport, NY 11768
Professor and Vice Chair for Research, Department of Surgery
Stony Brook University, School of Medicine
Stony Brook, NY
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Since the 1990’s, two different approaches have been commonly used by cardiac surgeons to perform an adult coronary artery bypass graft (CABG) procedure, these approaches have been referred to as “on-pump” (with cardiopulmonary bypass) or “off-pump” (without cardiopulmonary bypass) procedures. The Department of Veterans Affairs (VA) Randomized On/Off Bypass Follow-up Study” (ROOBY-FS) compared the relative performance of off-pump versus on-pump approaches upon 5-year patients’ clinical outcomes including mortality and major adverse cardiovascular events.
MedicalResearch.com: What are the main findings?
Response: Based on the VA ROOBY-FS 5-year follow-up findings reported in the recent New England Journal of Medicine publication [please put reference or link here], the off-pump coronary bypass approach was associated with lower survival and event-free survival rates as compared to the on-pump technique.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: For the majority of CABG patients, these ROOBY-FS findings support the 2012 Cochrane systematic review’s prior conclusion that “on-pump CABG should continue to be the standard surgical treatment”.  For unusual clinical situations (such as CABG patients with a highly calcified aorta), however, additional data-driven evidence is required, as these patients may potentially have better outcomes using an off-pump approach. Future research appears warranted to identify the patient risk factors and cardiac surgical processes of care which impact longer-term coronary revascularization procedural stability and durability – towards the goal of improving long-term event-free survival; additional research should also identify the optimal approach (either on-pump or off-pump) for inherently higher “at risk” patient sub-groups.
MedicalResearch.com: Is there anything else you would like to add?
Response: The VA ROOBY-FS (CSP#517-FS) was sponsored by the Department of Veterans Affairs (VA) Office of Research and Development Cooperative Studies Program (CSP) and supported, in part, by the Offices of Research and Development at both the Northport VA and the Eastern Colorado Health Care System Denver VA Medical Centers. With the full text article, the author disclosures are available online at NEJM.org site.
- Møller CH, Penninga L, Wetterslev J, Steinbruchel DA, Gluud C. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. Cochrane Database of Systematic Reviews 2012;14:3.
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N Engl J Med 2017; 377:623-632
August 17, 2017 DOI: 10.1056/NEJMoa161434
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