Surgeons within the Veterans Affairs health system have become less likely to perform coronary artery bypass grafting (CABG) without the support of cardiopulmonary bypass in recent years, researchers found.

The use of off-pump CABG peaked in 2003 -- when it accounted for 24 percent of such operations -- and fell to about 19 percent by 2011, according to Faisal Bakaeen, MD, of the Michael E. DeBakey VA Medical Center in Houston, and colleagues.

From 1997 to 2011, perioperative mortality dropped for both off-pump and on-pump CABG, remaining below 2 percent since 2006, the researchers reported online in JAMA Surgery.

Mortality was consistently high, however, for cases that involved a conversion from an off-pump to on-pump procedure.

"The clinical implication of this study is that for the average VA surgical practice, there should be no pressure to either perform or avoid [on-pump] CABG," Bakaeen and colleagues wrote. "Rather, the focus should be on which is the best approach for the patient. Converted cases have higher mortality, and this should be considered when planning an operation and in the formulation of the perioperative care."

To avoid potential complications associated with cardiopulmonary bypass, some surgeons started using off-pump CABG.

Recent trials comparing on-pump versus off-pump CABG -- including the ROOBY trial and the CORONARY trial -- have failed to show a significant difference in hard clinical endpoints, although there have been some differences in secondary endpoints.

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