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Observational Study
. 2016 May;22(5):612-8.
doi: 10.1093/icvts/ivw005. Epub 2016 Feb 16.

Is off-pump technique a safer procedure for coronary revascularization? A propensity score analysis of 20 years of experience

Paula Carmona  1 , Federico Paredes  2 , Eva Mateo  3 , Armando V Mena-Durán  4 , Fernando Hornero  4 , Juan Martínez-León  4
Affiliations
Observational Study

Is off-pump technique a safer procedure for coronary revascularization? A propensity score analysis of 20 years of experience

Paula Carmona et al. Interact Cardiovasc Thorac Surg. 2016 May.

Abstract

Objectives: We aim to describe our experience in coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass by comparing intraoperative and postoperative outcomes.

Methods: From January 1993 to June 2013, 3097 patients underwent consecutive emergency and scheduled CABG surgery. A total of 1770 patients underwent on-pump CABG (ONCABG) and 1327 off-pump CABG (OPCABG). A propensity score matching was performed to identify appropriate matched-pair patients; univariable and multivariable logistic regression analyses were performed to assess significant predictors of hospital and 30-day morbidity and mortality composite end-points. Morbidity composite end-point was defined as any renal, pulmonary, cardiovascular and neurological complication that occurred during hospital stay. We collected all-cause mortality data during the study period.

Results: We identified 1004 patients in each group. There were no significant differences in thirty day mortality, 2.8 vs 3.8%, in OPCABG and ONCABG, respectively (P = 0.21). Cardiovascular, neurological, respiratory and renal complications were more frequent in the ONCABG group: 13.9 vs 8.7% (P < 0.001), 3.9 vs 2.2% (P = 0.03), 13.5 vs 7.5% (P < 0.001), 7.1 vs 5.3% (P = 0.095), respectively. The long-term all-cause mortality rate was 12.3 vs 12.9% in the OPCABG versus ONCABG group (P = 0.42), respectively. In both uni- and multivariable analysis preoperative renal failure, chronic obstructive pulmonary disease and ONCABG were independent predictors of mortality and morbidity composite end-points.

Conclusions: OPCABG is associated with less postoperative morbimortality and shorter hospital and intensive care unit length of stay. ONCABG resulted as an independent predictor of morbidity and mortality composite end-point. No statistically significant differences were observed in long-term all-cause mortality between groups.

Keywords: Coronary artery bypass graft; Off-pump; On-pump; Outcomes; Survival.

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Figures

Figure 1:
Figure 1:
Cumulative survival. OPCABG: off-pump coronary artery bypass graft; ONCABG: on-pump coronary artery bypass graft; CI: confidence interval.
See this image and copyright information in PMC

Comment in

References

    1. Kolh P, Windecker S, Alfonso F, Collet JP, Cremer J, Falk V et al. . 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 2014;46:517–92. - PubMed
    1. Warren OJ, Smith AJ, Alexiou C, Rogers PL, Jawad N, Vincent C et al. . The inflammatory response to cardiopulmonary bypass: part 1—mechanisms of pathogenesis. J Cardiothorac Vasc Anesth 2009;23:223–31. - PubMed
    1. Takagi H, Watanabe T, Mizuno Y, Kawai N, Umemoto T. A meta-analysis of adjusted risk estimates for survival from observational studies of complete versus incomplete revascularization in patients with multivessel disease undergoing coronary artery bypass grafting. Interact CardioVasc Thorac Surg 2014;18:679–82. - PubMed
    1. Takagi H, Goto SN, Watanabe T, Mizuno Y, Kawai N, Umemoto T. A meta-analysis of adjusted hazard ratios from 20 observational studies of bilateral versus single internal thoracic artery coronary artery bypass grafting. J Thorac Cardiovasc Surg 2014;148:1282–90. - PubMed
    1. Moller CH, Penninga L, Wetterslev J, Steinbruchel DA, Gluud C. Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease. Cochrane Database Syst Rev 2012;3:CD007224. - PMC - PubMed

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