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To the Editor: Dr Puskas and colleagues¹ reported that patients who underwent off-pump coronary artery bypass graft (CABG) surgery had similar degrees of 1-year graft patency, as well as similar 30-day and 1-year health-related quality of life, as patients who underwent on-pump CABG surgery. I am concerned that the authors did not describe the details of perfusion technique. There have been major changes in techniques in reducing priming volumes as well as use of low-prime circuits.² Pump runs with high volumes of crystalloid are likely to be associated with significantly different oucomes than those with low volumes. It is possible that results for on-pump and off-pump CABG surgery were confounded with perfusion practice.

Kirti Patel, MPH
patelpump@aol.com
Beaumont, Tex

1. Puskas JD, Williams WH, Mahoney EM, et al. Off-pump vs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial. JAMA. 2004;291:1841-1849. FREE FULL TEXT 2. Eising GP, Pfauder M, Niemeyer M, et al. Retrograde autologous priming: is it useful in elective on-pump coronary artery bypass surgery? Ann Thorac Surg. 2003;75:23-27. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;292:169.

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