A prospective evaluation of hemodynamic instability during off-pump coronary artery bypass surgery

Mishra, Manisha; Shrivastava, Savitri; Dhar, Ajay; Bapna, Ramesh; Mishra, Anil; Meharwal, Zile Singh; Trehan, Naresh

doi:10.1016/s1053-0770(03)00149-6

Cited by 46 publications

(22 citation statements)

References 13 publications

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“…Elevated body mass index and its effect on patient outcome following CABG surgery remains controversial but has been suggested by some to result in worse outcome [24]. We were unable to confirm previously suggested predictors of conversion which have included: previous CABG, congestive heart failure, surgeon with early experience, low ejection fraction, and recent myocardial infarction [8,10,25,26]. Similarly, we believe that any conclusion as to why converted patients may have a higher morbidity and mortality would be speculative.…”

Section: Discussionmentioning

confidence: 77%

Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial☆

Légaré

Buth²,

Hirsch

2005

European Journal of Cardio-Thoracic Surgery

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Section: Discussionmentioning

confidence: 77%

Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial☆

Légaré

Buth²,

Hirsch

2005

European Journal of Cardio-Thoracic Surgery

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“…It is reasonable to assume that straightforward cases with favourable risk profiles will not require conversion. However, where patients present with risk factors predictive of several-fold increase in the risk of conversion, such as poor cardiac function [18,20,40], poor-quality coronary targets [20,40,41], prior myocardial infarction [22,40], redo or salvage revascularisation [18,22] or chronic obstructive pulmonary disease [23,30], informed consent should be obtained, accounting for the possibility of conversion. It is desirable, perhaps, for future research to be directed towards developing a system for predicting the individual patient's risk of conversion.…”

Section: Consent Issuesmentioning

confidence: 99%

Intra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis

Mukherjee

Ashrafian

Kourliouros

et al. 2012

European Journal of Cardio-Thoracic Surgery

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Coronary artery bypass surgery can offer excellent results when performed with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass (off pump). The debate as to which technique is superior remains unanswered. Intra-operative conversion from off- to on-pump coronary surgery is a relatively unexplored phenomenon, which cannot be assessed within randomised controlled trial design. We aimed to assess the effect of off-pump conversion on patient mortality. Medline, Embase, Cochrane and Google Scholar databases were systematically reviewed for studies published between 1980 and 2010 that compared the incidence of mortality between converted and non-converted off-pump patients. Publication bias and heterogeneity were assessed and data were extracted independently by multiple observers. We undertook a meta-analysis of these studies using random effects modelling. A total of 17 studies fulfilled our inclusion criteria, containing data for 18,870 off-pump coronary artery bypass operations spanning a decade (1998-2008), involving 920 cases of conversion. Overall, conversion increased mortality by an odds ratio of 6.18 (95% confidence interval 4.65-8.20), whereas emergency conversion further raised the odds ratio of mortality to 6.99 (95% confidence interval 5.18-9.45). The conversion from off- to on-pump cardiac surgery may significantly increase the chance of an adverse outcome, whereas emergency conversion confers a significant rise in mortality. The risk of conversion should be discussed when obtaining the patient's informed consent and its prevention warrants serious consideration by cardiac surgeons and cardiac surgical training programmes.

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“…Patients who require conversion experience higher morbidity and mortality rates. Although some previous studies [7][8][9][10][11][12][13][14] have focused on patients requiring conversion, the debate on off-pump vs. on-pump procedures is ongoing. We therefore evaluated the outcome of patients who were converted owing to haemodynamic instability, with the aim of identifying predictors for the need to convert and of evaluating whether temporal trends and learning curve exist.…”

Section: Introductionmentioning

confidence: 99%

The outcome of patients requiring emergency conversion from off-pump to on-pump coronary artery bypass grafting

Landoni

Pappalardo

Crescenzi

et al. 2007

European Journal of Anaesthesiology

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A prospective evaluation of hemodynamic instability during off-pump coronary artery bypass surgery

Cited by 46 publications

References 13 publications

Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial☆

Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial☆

Intra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis

The outcome of patients requiring emergency conversion from off-pump to on-pump coronary artery bypass grafting

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