{"id":"b259a83b2ed3","type":"article","url":"https://hartvaat.nl/2019/08/13/off-pump-versus-on-pump-cabg-bij-hoofdstamcoronairlijden/","title":"Off-pump versus on-pump CABG bij hoofdstamcoronairlijden","title_en":"Off-Pump Versus On-Pump Bypass Surgery for Left Main Coronary Artery Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.05.063","source_url":"https://doi.org/10.1016/j.jacc.2019.05.063","authors":["Umberto Benedetto","John Puskas","Arie Pieter Kappetein","W Morris Brown","Ferenc Horkay","Piet W Boonstra","Gabor Bogáts","Nicolas Noiseux","Ovidiu Dressler","Gianni D Angelini","Gregg W Stone","Patrick W Serruys","Joseph F Sabik","David P Taggart"],"significance":6,"published":"2019-08-13","source_date":"2019-08-13","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/"],"congress":"","summary_en":"This comparison of off-pump versus on-pump CABG specifically for left main disease addressed concerns about completeness of revascularization and outcomes with the beating-heart approach in this complex surgical indication.","created":"2026-07-03T10:28:05Z","updated":"2026-07-03T13:27:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van off-pump versus on-pump CABG specifiek bij linker-hoofdstamcoronairlijden.","abstract_original":"BACKGROUND: Concerns remain for a greater risk of incomplete revascularization and reduced survival with off-pump coronary artery bypass grafting (CABG) surgery compared with on-pump surgery particularly in patients with left main disease and extensive underlying myocardial ischemia. OBJECTIVES: This study sought to compare outcomes following off-pump versus on-pump surgery for left main disease by performing a post hoc analysis from the multicenter, randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. METHODS: The EXCEL trial was designed to compare percutaneous coronary intervention with everolimus-eluting stents versus CABG in patients with left main disease. CABG was performed with or without cardiopulmonary bypass (on-pump vs. off-pump surgery) according to the discretion of the operator. The 3-year outcomes in the off-pump and on-pump groups were compared using inverse probability of treatment weighting (IPTW) for treatment effect estimation. RESULTS: Among 923 CABG patients, 652 and 271 patients underwent on-pump and off-pump surgery, respectively. Despite a similar extent of disease, off-pump surgery was associated with a lower rate of revascularization of the left circumflex coronary artery (84.1% vs. 90.0%; p = 0.01) and right coronary artery (31.1% vs. 40.6%; p = 0.007). After IPTW adjustment for baseline differences, off-pump surgery was associated with a significantly increased risk of 3-year all-cause death (8.8% vs. 4.5%; hazard ratio: 1.94; 95% confidence interval: 1.10 to 3.41; p = 0.02) and a nonsignificant difference in the risk for the composite endpoint of death, myocardial infarction, or stroke (11.8% vs. 9.2%; hazard ratio: 1.28; 95% confidence interval: 0.82 to 2.00; p = 0.28). CONCLUSIONS: Among patients with left main disease treated with CABG in the EXCEL trial, off-pump surgery was associated with a lower rate of revascularization of the coronary arteries supplying the inferolateral wall and an increased risk of 3-year all-cause death compared with on-pump surgery."}