COMPARISON OF POSTOPERATIVE OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING (CABG) USING ON-PUMP CARDIOPULMONARY BYPASS VERSUS OFF-PUMP CABG AT A TERTIARY CARE CARDIAC CENTER
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Keywords
Coronary artery bypass grafting, off-pump CABG, postoperative outcomes
Abstract
Introduction: Coronary artery bypass grafting (CABG), is the most common surgical procedure for coronary artery disease. There are two basic techniques: On-pump CABG (cardiopulmonary bypass) and Off-pump CABG (performed on a beating heart). The two methods have different perioperative physiological effects and postoperative results, with the best technique still being a subject of debate.
Objective: To compare postoperative outcomes between on-pump and off-pump CABG.
Methodology: This comparative cross-sectional study was carried out at Fauji Foundation Hospital, Peshawar from 1st April 2025 to 30th September 2025 through consecutive non-probability sampling 340 patients who were scheduled to undergo isolated CABG were included and randomized into on-pump (n=170) and off-pump (n=170) groups. A structured proforma was used to gather the data on demographic variables, intra-operative findings and postoperative outcomes. Ventilation time, length of stay for the ICU, hospital, presence of postoperative complications, and in-hospital mortality were all outcomes. SPSS version 26 was used for data analysis, which included an independent-samples t-test and a chi-square test with a p-value ≤ 0.05 set for statistical significance.
Results: Baseline characteristics were comparable between groups. The ventilation time, stay in the ICU, and in the hospital were significantly less after OPCAB (p<0.001). Patients receiving blood transfusions, re-examination for bleeding, atrial fibrillation, and acute renal injury were significantly more common in the on-pump group (p<0.05).
Conclusion: Off-pump CABG has a major advantage over on-pump CABG in terms of better early postoperative outcomes and less morbidity; in-hospital mortality was comparable between the two methods.
References
2. Ibrahim, H.K., Global trends in cardiovascular mortality and risk factors: insights from WHO and Global Burden of Disease data. Libyan Open University Journal of Medical Sciences and Sustainability, 2025: p. 28-36.
3. Pająk, A., P. Jankowski, and T. Zdrojewski, The burden of cardiovascular disease risk factors: A current problem. Polish Heart Journal (Kardiologia Polska), 2022. 80(1): p. 5-15.
4. Khawaja, M., et al., Left main coronary artery disease: a contemporary review of diagnosis and management. Reviews in Cardiovascular Medicine, 2024. 25(2): p. 66.
5. Nguyen, D., et al., Coronary Artery Bypass Grafting: History, Landmark Trials, and the Evolution of Surgical Practice. International Journal of Angiology, 2026.
6. Raja, S.G., Global trends and practices in coronary artery bypass surgery. Academia Medicine, 2025. 2(3).
7. Leivaditis, V., et al., Between air and artery: a history of cardiopulmonary bypass and the rise of modern cardiac surgery. Journal of cardiovascular development and disease, 2025. 12(9): p. 365.
8. Roberts, A., et al., Complications of cardiopulmonary bypass from an anesthesia perspective: a clinical review. HCA healthcare journal of medicine, 2023. 4(1): p. 13.
9. Kant, S., et al., Microvascular dysfunction following cardiopulmonary bypass plays a central role in postoperative organ dysfunction. Frontiers in medicine, 2023. 10: p. 1110532.
10. Naeem, M.W., et al., Exploring Complications After Coronary Artery Bypass graft in Cardiothoracic Intensive Care Unit at Assuit University. Assiut Scientific Nursing Journal, 2022. 10(29): p. 39-47.
11. Yoo, K.-J., The past, present, and future of off-pump coronary artery bypass grafting. Journal of Chest Surgery, 2025. 58(4): p. 121.
12. Cserép, Z., IDENTIFYING PSYCHOSOCIAL FACTORS INFLUENCING SHORT-AND LONG-TERM MORTALITY AND MORBIDITY AFTER ADULT CARDIAC SURGERY. 2025.
13. Siontis, K.C., et al., Associations of atrial fibrillation after noncardiac surgery with stroke, subsequent arrhythmia, and death: a cohort study. Annals of internal medicine, 2022. 175(8): p. 1065-1072.
14. Davoodi, S., et al., Early outcome of off-pump versus on-pump coronary revascularization. The Pan African medical journal, 2014. 17: p. 309.
15. He, L., et al., Clinical outcomes of on-pump versus off-pump coronary-artery bypass surgery: a meta-analysis. International Journal of Surgery, 2024. 110(8): p. 5063-5070.
16. Comanici, M., N. Bithi, and S.G. Raja, Comparison of outcomes between total arterial off-pump versus on-pump coronary artery bypass surgery: a meta-analysis and meta-regression. The American Journal of Cardiology, 2025. 249: p. 43-50.
17. Zhang, S., et al., A meta-analysis of early, mid-term and long-term mortality of on-pump vs. off-pump in redo coronary artery bypass surgery. Frontiers in Cardiovascular Medicine, 2022. 9: p. 869987.
18. Comanici, M., H.I. Bulut, and S.G. Raja, 10-Year mortality of off-pump versus on-pump coronary artery bypass grafting: an updated systematic review, meta-analysis, and meta-regression. The American Journal of Cardiology, 2024. 219: p. 77-84.
19. Lin, Y., et al., Anesthesia management of patients undergoing off-pump coronary artery bypass grafting: A retrospective study of single center. Frontiers in Surgery, 2023. 9: p. 1067750.
20. Ruengsakulrach, P., P. Jetwanna, and N. Arayawudhikul, Minimally Invasive Cardiac Surgery: A Practical Overview for Clinicians. The Bangkok Medical Journal, 2026. 22(1).
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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Dr Khawar Nawaz Khan
cardiac surgeon, Department: cardiothoracic surgery, Shifa International Hospital, Islamabad.
Dr. Sajid Khan
Consultant Cardiac Surgeon, MTI LRH Peshawar.
Dr .Hussain Shah
Consultant Adult Cardiac surgeon, Cardiovascular and Thoracic surgery Unit, NWGH & Research Centre Peshawar
Dr. Muhammad zaid Ali
Consultant Adult Cardiac surgeon, Cardiothoracic sciences division, SIUT Karachi
Dr Baha Ud Din
Associate Professor Cardiothoracic Surgery, Consultant Adult Cardiac Surgeon,
Syed Mansoor Hussain Shah
Registrar Cardiac Surgeon Cardiac Family, Fauji Foundation Hospital Peshawar
