1. Aron, Adrian MS

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Clinical evidence supports lower morbidity with off-pump coronary revascularization surgery as well as superior short- and mid-term outcomes, equivalent graft patency, and reduced cost. It has not been determined whether these advantages impact performance in cardiac rehabilitation.



To compare cardiac rehabilitation outcomes between patients undergoing on-pump versus off-pump coronary artery bypass surgery.



Data was retrospectively examined for patients who participated in cardiac rehabilitation between 1996 and 2004. Two hundred ninety five patients who underwent bypass surgery and completed at least 80% of their 36 required sessions were divided into On-Pump and Off-Pump groups. Anthropometric characteristics included weight and abdominal and hip circumferences. Pre and post cardiac rehabilitation measures included: grip strength, flexibility, calories expended during class, quality of life, and self-efficacy.



Both groups were similar with respect to age, sex, ejection fraction, length of stay, time from discharge to program start, and mean number of grafts. There were no statistical differences between the On-Pump and Off-Pump groups (P >.05) for weight, abdominal and hip circumferences, grip strength, flexibility, and total caloric expenditure. In addition, there were no between group (On-Pump versus Off-Pump) differences regarding quality of life (P =.20), and self-efficacy (P =.30). Grip strength (36.5 +/- 11.2 vs. 38.5 +/- 11.8, P <.01), flexibility (13.4 +/- 12.5 vs. 16.8 +/- 9.9, P <.01) and caloric expenditure during class (145.2 +/- 66.5 vs. 281.4 +/- 118.7, P <.01) improved with cardiac rehabilitation regardless of the surgical procedure. In addition, quality of life (4.4 +/- 0.9 vs. 5.9 +/- 0.8, P <.01) and self efficacy (49.1 +/- 21.0 vs. 73.0 +/- 21.4, P <.01) increased.



The present data support the concept that even though there are clinical advantages to off-pump surgery, there is no benefit over on-pump regarding cardiac rehabilitation. Subsequently, off-pump surgical patients should be managed similarly as their on-pump counterparts.