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. 2022 Mar 15;11(6):e023514.
doi: 10.1161/JAHA.121.023514. Epub 2022 Mar 1.

Off-Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs' Use and Outcomes

Salil V Deo  1   2   3 , Yakov Elgudin  1   2 , A Laurie W Shroyer  4   5 , Salah Altarabsheh  6   7 , Vikas Sharma  8   9 , Joseph Rubelowsky  1   2 , Lorraine Cornwell  10 , Piroze Davierwala  11 , Danny Chu  12 , Brian Cmolik  1   2
Affiliations

Off-Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs' Use and Outcomes

Salil V Deo et al. J Am Heart Assoc. .

Abstract

Background Coronary artery bypass can be performed off pump (OPCAB) without cardiopulmonary bypass. However, trends over time for OPCAB versus on-pump (ONCAB) use and long-term outcome has not been reported, nor has their long-term outcome been compared. Methods and Results We queried the national Veterans Affairs database (2005-2019) to identify isolated coronary artery bypass procedures. Procedures were classified as OPCAB on ONCAB using the as-treated basis. Trend analyses were performed to evaluate longitudinal changes in the preference for OPCAB. The median follow-up period was 6.6 (3.5-10) years. An inverse probability weighted Cox model was used to compare all-cause mortality between OPCAB and ONCAB. From 47 685 patients, 6759 (age 64±8 years) received OPCAB (14%). OPCAB usage declined from 16% (2005-2009) to 8% (2015-2019). Patients with triple vessel disease who received OPCAB received a lower mean number of grafts (2.8±0.8 versus 3.2±0.8; P<0.01). The ONCAB 5-, 10-, and 15-year survival rates were 82.9% (82.5-83.3), 60.4% (59.8-61.1), and 37.2% (36.1-38.4); correspondingly, OPCAB rates were 80.7% (79.7-81.7), 57.4% (56-58.7), and 34.1% (31.7-36.6) (P<0.01). OPCAB was associated with increased risk-adjusted all-cause mortality (hazard ratio, 1.15 [1.13-1.18]; P<0.01) and myocardial infarction (incident rate ratio, 1.16 [1.05-1.28]; P<0.01). Conclusions Over 15 years, OPCAB use declined considerably in Veterans Affairs medical centers. In Veterans Affairs hospitals, late all-cause mortality and myocardial infarction rates were higher in the OPCAB cohort.

Keywords: coronary artery bypass grafting; long term survival; myocardial infarction; off‐pump surgery.

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Figures

Figure 1
Figure 1. This flow chart presents the cohort selection process used to identify patients that receiving isolated coronary artery bypass grafting at nationwide Veteran Affairs medical centers between January 2005 and September 2019.
CABG indicates coronary artery bypass grafting; ONCAB, on‐pump coronary artery bypass grafting; and OPCAB, off‐pump coronary artery bypass grafting.
Figure 2
Figure 2. VA medical centers were stratified depending upon the OPCAB volume in each time period (2005–2009 and 2015–2019) into low volume (<10% of total procedures performed OPCAB), moderate volume (10%–30% of total procedures performed OPCAB), and high volume (>30% total procedures performed OPCAB).
As depicted in the figure, we observed a decline in high and moderate volume centers between the first (2005–2009) and last (2015–2019) time periods. *‐1 center that reported data in 2005 to 2009 did not report data between 2015 and 2019. OPCAB indicates off‐pump coronary artery bypass grafting; and VAMC, Veterans Affairs Medical Center.
Figure 3
Figure 3. This graph presents the unadjusted survival estimates calculated by the Kaplan‐Meier method for the patients undergoing on‐pump and off‐pump isolated coronary artery bypass grafting during the study period.
ONCAB indicates on‐pump coronary artery bypass grafting; and OPCAB, off‐pump coronary artery bypass grafting.
See this image and copyright information in PMC

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