Introduction There is controversy in the literature regarding the long‐term outcomes of off‐pump coronary artery bypass (OPCAB) compared to conventional on‐pump coronary artery bypass (ONCAB) grafting. Methods We retrospectively reviewed prospectively collected data on first‐time elective or urgent isolated CABG patients (1996–2023). The primary objective was to compare long‐term survival between patients who underwent OPCAB or ONCAB after inverse probability of treatment weighting (IPTW). Long‐term survival was then categorised into a learning phase (1996–2002), a consolidation phase (2003–2012) and a specialist phase (2013–2023) of the OPCAB technique. Results A total of 16,941 patients (46.75% OPCAB), with a median age of 66.8 years, were included, of whom 82.32% were male. The use of OPCAB increased until 2008 (78.11%), after which it steadily decreased to 35.52% in 2022. After IPTW, the OPCAB cohort, when compared with ONCAB, had a lower incidence of cerebrovascular accidents (0.51% vs. 1.09%, p < 0.0001). In addition, the OPCAB group were less likely to return to theatre (RTT) overall (3.46% vs. 4.08%, p = 0.0028), with post hoc testing showing they were less likely to RTT for bleeding or tamponade (2.27% vs. 3.14%, p < 0.0001) but more likely to RTT for graft revision (0.17% vs. 0.09%, p = 0.0316). There was no difference in in‐hospital mortality between the groups (log‐rank p = 0.70). During the learning phase, the OPCAB group had a lower survival rate than the OPCAB group (log‐rank p = 0.018). However, in the specialist phase, OPCAB patients had a higher survival probability than ONCAB patients (log‐rank p = 0.016). Conclusion OPCAB, compared with ONCAB, was associated with a lower incidence of CVA. Overall, long‐term mortality was similar in the two groups. OPCAB, after the initial learning curve, was associated with higher long‐term survival compared to ONCAB grafting when performed by experienced surgeons.
Garlick et al. (Thu,) studied this question.