Outcome of Cardiac Rehabilitation Following Off-Pump Versus On-Pump Coronary Bypass Surgery


  • Reza Arefizadeh Department of Cardiology, AJA University of Medical Sciences, Tehran
  • Seyed Yaser Hariri Khatamolanbia Air Defence Medical University, Tehran
  • Adel Johari Moghadam Khatamolanbia Air Defence Medical University, Tehran




coronary artery bypass, cardiac rehabilitation, outcome, quality of life


BACKGROUND: A few studies have compared the cardiac rehabilitation (CR) outcome between those who undergo conventional on-pump bypass surgery and off-pump surgery. We compared this outcome among the patients differentiated by the On-pump and off-pump surgical procedures about cardiovascular variables and psychological status.

METHODS: This longitudinal study recruited 318 and 102 consecutive patients who had undergone CABG (on-pump surgery, n = 318 and off-pump surgery, n = 102) and been referred to the CR clinic.

RESULTS: The off-pump surgery patients had more improvement in their metabolic equivalents (METs) value. The physical and mental components of health-related quality of life (QOL) (based on SF-36 questionnaire) as well as depression-anxiety (based on Costello-Comrey Depression and Anxiety Scale) were notably improved in the two study groups after the CR program, while changes in the QOL components scores and also depression-anxiety score were not different between the off-pump and on-pump techniques.

CONCLUSIONS: Regarding QOL and psychological status, there were no differences in the CR outcome between those who underwent off-pump bypass surgery and those who underwent on-pump surgery; nevertheless, the off-pump technique was superior to the on-pump method on METs improvement following CR.


Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


Beckermann J, Van Camp J, Li S, Wahl SK, Collins A, Herzog CA. On-pump versus off-pump coronary surgery outcomes in patients requiring dialysis: perspectives from a single center and the United States experience. J Thorac Cardiovasc Surg. 2006;131(6):1261-6. https://doi.org/10.1016/j.jtcvs.2005.12.060 PMid:16733155

Bucerius J, Gummert JF, Walther T, Schmitt DV, Doll N, Falk V, Mohr FW. On-pump versus off-pump coronary artery bypass grafting: impact on postoperative renal failure requiring renal replacement therapy. Ann Thorac Surg. 2004;77(4):1250-6. https://doi.org/10.1016/S0003-4975(03)01346-8

Diegeler A, Hirsch R, Schneider F, Schilling LO, Falk V, Rauch T, Mohr FW. Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation. Ann Thorac Surg. 2000;69(4):1162-6. https://doi.org/10.1016/S0003-4975(99)01574-X

Mack M, Bachand D, Acuff T, Edgerton J, Prince S, Dewey T, Magee M. Improved outcomes in coronary artery bypass grafting with beating-heart techniques. J Thorac Cardiovasc Surg. 2002;124(3): 598-607. https://doi.org/10.1067/mtc.2002.124884 PMid:12202877

Puskas JD, Williams WH, Duke PG, Staples JR. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125(4):797-808. https://doi.org/10.1067/mtc.2003.324 PMid:12698142

Buffolo E, de Andrade CS, Branco JN, Teles CA, Aguiar LF, Gomes WJ. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg. 1996;61(1):63-6. https://doi.org/10.1016/0003-4975(95)00840-3

Nathoe HM, van Dijk D, Jansen EW, Suyker WJ. A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients. N Engl J Med. 2003;348(5): 394-402. https://doi.org/10.1056/NEJMoa021775 PMid:12556542

Van Dijk D, Jansen EW, Hijman R. Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial. JAMA. 2002;287(11): 1405-1412. https://doi.org/10.1001/jama.287.11.1405 PMid:11903027

van Dijk D, Nierich AP, Jansen EW, Nathoe HM. Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation. 2001;104(15): 1761-1766. https://doi.org/10.1161/hc4001.097036 PMid:11591611

Cardiac rehabilitation programs. A statement for healthcare professionals from the American Heart Association. Circulation. 1994;90(3):1602-1610. https://doi.org/10.1161/01.CIR.90.3.1602

Ades PA. Cardiac rehabilitation and secondary prevention of coronary heart disease. N Engl J Med. 2001; 345(12):892-902. https://doi.org/10.1056/NEJMra001529 PMid:11565523

Franklin BA, Gordon S, Timmis GC. Amount of exercise necessary for the patient with coronary artery disease. Am J Cardiol. 1992;69(17): 1426-1432. https://doi.org/10.1016/0002-9149(92)90895-6

Oldridge NB, Guyatt GH, Fischer, ME, Rimm AA. Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials. JAMA. 1988;260(7):945-950. https://doi.org/10.1001/jama.1988.03410070073031 PMid:3398199

Gardner JK, McConnell TR, Klinger TA, Herman CP, Hauck CA, Laubach Jr CA. Quality of life and self-efficacy: gender and diagnoses considerations for management during cardiac rehabilitation. J Cardiopulm Rehabil. 2003;23(4):299-306. https://doi.org/10.1097/00008483-200307000-00007 PMid:12894004

Hung C, Daub B, Black B, Welsh R, Quinney A, Haykowsky M. Exercise training improves overall physical fitness and quality of life in older women with coronary artery disease. Chest. 2004;126(4):1026-31. https://doi.org/10.1016/S0012-3692(15)31272-1

Aron A, Klinger TA, McConnell TR. Cardiac rehabilitation outcomes no different after on-pump versus off-pump coronary artery bypass surgery. J Cardiopulm Rehabil Prev. 2007;27(1):35-41. https://doi.org/10.1097/01.HCR.0000265018.11037.1a PMid:17474642

Shekar PS. Cardiology patient page. On-pump and off-pump coronary artery bypass grafting. Circulation. 2006;113(4): e51-52. https://doi.org/10.1161/CIRCULATIONAHA.105.566737 PMid:16449717

Ware JE, Kosinski M, Dewey JE. How to score version 2 of the SF-36 health survey: standars & acute forms: QualityMetric, 2001.

Costello CG, Comrey AL. Scales for measuring depression and anxiety. J Psychol. 1967;66(2): 303-313. https://doi.org/10.1080/00223980.1967.10544910 PMid:6076427

Warang M, Waradkar A, Patwardhan A, Agrawal N, Kane D, Parulkar G, Khandeparkar J. Metabolic changes and clinical outcomes in patients undergoing on and off pump coronary artery bypass surgery. Indian Journal of Thoracic and Cardiovascular Surgery. 2007;23(1): 9-15. https://doi.org/10.1007/s12055-007-0003-z

Pojar M., Mand'ak J, Cibicek N, Lonsky V, Dominik J, Palicka V, Kubicek J. Peripheral tissue metabolism during off-pump versus on-pump coronary artery bypass graft surgery: the microdialysis study. Eur J Cardiothorac Surg. 2008;33(5): 899-905. https://doi.org/10.1016/j.ejcts.2008.01.039 PMid:18328724

Weiland AP, Walker WE. Physiologic principles and clinical sequelae of cardiopulmonary bypass. Heart Lung. 1986;15(1):34-39. PMid:3511011

Shroyer AL, Grover FL, Hattler B, Collins JF. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med. 2009;361(19);1827-1837. https://doi.org/10.1056/NEJMoa0902905 PMid:19890125

Jensen BO, Hughes P, Rasmussen LS, Pedersen PU, Steinbruchel DA. Health-related quality of life following off-pump versus on-pump coronary artery bypass grafting in elderly moderate to high-risk patients: a randomized trial. Eur J Cardiothorac Surg. 2006;30(2):294-299. https://doi.org/10.1016/j.ejcts.2006.04.015 PMid:16829089

Motallebzadeh R, Bland, JM, Markus, HS, Kaski, JC, Jahangiri M. Health-related quality of life outcome after on-pump versus off-pump coronary artery bypass graft surgery: a prospective randomized study. Ann Thorac Surg; 2006;82(2): 615-619. https://doi.org/10.1016/j.athoracsur.2006.03.081 PMid:16863773

Outpatient Cardiac Rehabilitation and Secondary Prevention. In American Association of Cardiovascular & Pulmonary Rehabilitation (Eds.), Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs: Human Kinetics, 1999.



How to Cite

Arefizadeh R, Hariri SY, Moghadam AJ. Outcome of Cardiac Rehabilitation Following Off-Pump Versus On-Pump Coronary Bypass Surgery. Open Access Maced J Med Sci [Internet]. 2017 May 7 [cited 2022 Aug. 14];5(3):290-4. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2017.057



B - Clinical Sciences