Dr. John Puskas Presents the Long-Term Results of his Landmark SMART Study

February 2010

Dr. John Puskas, lead investigator of the landmark SMART (Surgical Management of Arterial Revascularization) investigation, presented the long-term results of the study at the Society of Thoracic Surgeons' 46th Annual Meeting in Fort Lauderdale, Fla. Results of the original study, the first randomized US trial to compare off-pump coronary artery bypass (OPCAB) with conventional coronary artery bypass graft surgery (CABG) surgery, were published in April 2004 by the Journal of the American Medical Association and showed that CABG surgery performed on a beating heart without a heart-lung machine was medically beneficial, that patients recovered faster with OPCAB than with conventional CABG, and that it was as effective as CABG in restoring blood flow and maintaining revascularization to the heart muscle over time.

The long-term follow-up data confirmed that outcomes were similar based on an analysis of early- and late-graft patency (freedom from blockage), incidence of recurrent heart attack, need for re-intervention, and long-term survival between the two procedures at a mean of nearly eight years after surgery.

Data confirming the durability of off-pump surgery complement conclusions from numerous previous studies showing that OPCAB offers significant post-operative patient benefits by reducing the risk of complications. This is particularly true among high-risk patients, such as those with other medical conditions, including diabetes, a history of stroke, or poor physical health, or the elderly, obese and women, who typically do not fare as well under conventional cardiopulmonary bypass procedures.

"This provides additional evidence that the early benefits of OPCAB are not obtained at the expense of long-term survival or freedom from re-intervention," says Dr. Puskas. "The SMART follow-up data add to the growing body of evidence supporting the long-term durability of OPCAB, including randomized studies performed in the U.K. and 10-year follow-up of CABG patients at our university."