{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T03:51:44Z","timestamp":1765425104578,"version":"3.46.0"},"reference-count":0,"publisher":"Annali Italiani di Chirurgia","issue":"12","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann. Ital. Chir."],"abstract":"<jats:p>AIM: Coronary artery bypass grafting (CABG), whether conducted using on-pump or off-pump strategies, exhibits distinct perioperative risk profiles. When combined with left internal mammary artery (LIMA) to left anterior descending artery (LAD) grafting and sequential no-touch saphenous vein graft (SVG) anastomosis, these differences gain clinical relevance. Therefore, this study aims to compare the clinical outcomes of on-pump CABG and off-pump CABG in patients who uniformly received the LIMA-LAD graft combined with sequential no-touch SVG anastomosis. METHODS: This retrospective cohort study included 240 patients who received LIMA-LAD grafting combined with sequential no-touch SVG anastomosis between June 2019 and December 2023. Of the total patients, 61 received the procedure under cardiopulmonary bypass and were assigned to the on-pump group, while 179 underwent off-pump coronary artery bypass, categorized as the off-pump group. After propensity score matching (PSM; 1:1 ratio), 57 pairs were successfully matched and analyzed. The primary endpoint of the study included the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause mortality, myocardial infarction, stroke, or target vessel revascularization, within one year after surgery. A key secondary endpoint was a graft patency rate assessed within one year after the procedure, including the LIMA-LAD graft and the sequential SVGs. Other secondary endpoints included: (1) postoperative recovery metrics, such as intensive care unit (ICU) stay duration, duration of mechanical ventilation, volume of thoracic drainage, and blood transfusion requirements; (2) hemodynamic parameters at 24 hours post-operation, including cardiac index (CI), pulmonary artery wedge pressure (PAWP), left ventricular stroke work index (LVSWI), stroke volume index (SVI), mean arterial pressure (MAP), and systemic vascular resistance index (SVRI); and (3) short-term postoperative complications (e.g., atrial fibrillation, acute kidney injury (AKI), sternal wound infection, and lower extremity venous territory infection). RESULTS: There was no significant difference in the one-year incidence of MACCE between the off-pump and on-pump groups (p &gt; 0.05). Similarly, no significant differences were found in the one-year patency rates of the LIMA-LAD graft or the sequential SVGs between the two groups (p &gt; 0.05). Compared to the on-pump group, the off-pump group had shorter ICU stays, reduced duration of mechanical ventilation, lower thoracic drainage volumes, and decreased blood transfusion requirements (p &lt; 0.001). Furthermore, no significant difference was observed in total hospitalization duration between the two groups (p &gt; 0.05). Preoperatively, none of the hemodynamic parameters achieved statistical significance between the two groups (p &gt; 0.05). At 24 hours postoperatively, both groups showed substantial within-group improvements (off-pump: all parameters; on-pump: CI, PAWP, LVSWI, SVRI; p &lt; 0.05). However, between-group comparisons revealed better CI, PAWP, LVSWI, SVI and SVRI levels in the off-pump group (p &lt; 0.05). Within 1 month postoperatively, the off-pump group experienced a lower incidence of atrial fibrillation (p &lt; 0.05). Additionally, there were no significant differences in the rates of AKI, sternal wound infection, or leg wound infection between the two groups within 2 months postoperatively (p &gt; 0.05). CONCLUSIONS: Compared to on-pump CABG, off-pump CABG utilizing sequential no-touch SVG anastomosis offers advantages in terms of earlier recovery and superior hemodynamic performance without compromising graft patency or increasing the long-term risk of major adverse cardiovascular and cerebrovascular events.<\/jats:p>","DOI":"10.62713\/aic.4311","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T01:57:16Z","timestamp":1765331836000},"source":"Crossref","is-referenced-by-count":0,"title":["On-Pump Versus Off-Pump Coronary Artery Bypass Grafting: A Comparison of Outcomes in Patients Receiving LIMA-LAD and Sequential No-Touch Saphenous Vein Graft Anastomoses"],"prefix":"10.62713","volume":"96","author":[{"given":"Xun","family":"Zhang","sequence":"first","affiliation":[{"name":"Department 3 of Cardiac and Great Vascular Surgery, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhikun","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department 3 of Cardiac and Great Vascular Surgery, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing","family":"Chang","sequence":"additional","affiliation":[{"name":"Department 3 of Cardiac and Great Vascular Surgery, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongkai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department 3 of Cardiac and Great Vascular Surgery, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chen","family":"Huang","sequence":"additional","affiliation":[{"name":"Department 3 of Cardiac and Great Vascular Surgery, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Xu","sequence":"additional","affiliation":[{"name":"Department 3 of Cardiac and Great Vascular Surgery, The First Affiliated Hospital of Zhengzhou University, 450052 Zhengzhou, Henan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"48935","published-online":{"date-parts":[[2025,12,10]]},"container-title":["Annali Italiani di Chirurgia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.annaliitalianidichirurgia.it\/journal\/AIC\/96\/12\/10.62713\/aic.4311","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T03:48:30Z","timestamp":1765424910000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.annaliitalianidichirurgia.it\/journal\/AIC\/96\/12\/10.62713\/aic.4311"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,10]]},"references-count":0,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025]]}},"alternative-id":["S0003-469X(25)00091-0"],"URL":"https:\/\/doi.org\/10.62713\/aic.4311","relation":{},"ISSN":["0003-469X","2239-253X"],"issn-type":[{"type":"print","value":"0003-469X"},{"type":"electronic","value":"2239-253X"}],"subject":[],"published":{"date-parts":[[2025,12,10]]},"article-number":"1669"}}