Discussion
three-vessel coronary artery disease
This study compared off-pump versus on-pump postoperative and long-term MACCE outcomes in 263 three-vessel coronary artery disease patients who underwent CABG surgery. At a median follow-up of 31.2 months, the groups had no significant difference in postoperative outcomes. In addition, we found no significant difference in rates of MACCE incidence between the groups at the end of the follow-up.Several studies have reported early and late outcomes between off-pump and on-pump during sequential follow-up intervals. However, their results are controversial in some aspects. Among large-scale trials, the CORONARY trial which is only one performed subgroup analysis for 3VD patients, reported no difference between off-pump and on-pump groups in MACCE outcomes after 30-days, 1-year, and 5-year follow-up in three distinct studies [There were no differences in postoperative outcomes between the off-pump and on-pump CABG groups in the current study. In contrary with our results, the MASS III trial reported a longer length of ICU stay, time to extubation, and hospital stay in off-pump patients [There are important differences between these trials, which these controversies may stem from. Different sample sizes, diverse clinical settings and eligibility criteria, primary outcomes, surgeon experience, and duration of follow-up can be mentioned as the most frequent reasons. Variations in eligibility criteria of previous studies, such as enrollment of high-risk patients [There is a trend of fewer completed grafts than originally planned in the off-pump group compared with the on-pump group in previous trials. CORONARY, ROOBY, and MASS III trials reported fewer grafts and/or a higher rate of incomplete revascularization (as assessed by the surgeon at the time of surgery) among the off-pump group [In the present study, all surgeries were done by a high-volume surgeon who is an expert in both methods. Squires et al. reported a correlation between surgeon experience and long-term outcomes and reduced mortality of off-pump among high-volume surgeons [Follow-up duration plays a vital role in the detection of MACCE. Reported follow-up durations varied among previous studies [Our trial has some limitations, according to the small sample size of the current study compared to large-scale trials, results need to be confirmed by subgroup analysis of 3VD patients in previous trials or further studies focused on this population. The present report does not include data on long-term morbidity and mortality. However, further follow-up and angiographic control of graft patency are planned, and the results will be published in the future.