Comparison of off-pump and on-pump coronary artery bypass grafting in midterm results

Ishida, Michiko; Kobayashi, Junjiro; Tagusari, Osamu; Bando, Ko; Niwaya, Kazuo; Nakajima, Hiroyuki; Fukushima, Satsuki; Kitamura, Soichiro

doi:10.1007/s11748-004-0117-9

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…Some authors reported increased reintervention rates following OPCAB compared to conventional CABG 3,7 . The etiology for higher than expected repeat revascularization may be attributed to early graft closure or progression of atherosclerosis in the previously ungrafted coronary arteries 8,9 . Others, however, have found similar graft patency rates 10 and similar reintervention rates during mid‐term follow‐up between on‐pump and off‐pump CABG 1,11,12 …”

Section: Discussionmentioning

confidence: 99%

Predictors of Mid-Term Symptom Recurrence, Adverse Cardiac Events and Mortality in 591 Unselected Off-Pump Coronary Artery Bypass Graft Patients

et al. 2006

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Section: Discussionmentioning

confidence: 99%

Predictors of Mid-Term Symptom Recurrence, Adverse Cardiac Events and Mortality in 591 Unselected Off-Pump Coronary Artery Bypass Graft Patients

et al. 2006

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“…Consequently, performing CABG on the beating heart without cardiopulmonary bypass (“off-pump”) was first introduced in the mid-1980s to reduce postoperative complications, especially in high-risk patients [ 7 ]. Although the long-term effectiveness of off-pump CABG (OPCABG) remains controversial, studies have shown that OPCABG reduces the operation time, the duration of intensive care unit (ICU) admission, the rate of blood transfusion, and early morbidity [ 4 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery; statistical challenges in comparison

Sheikhy

Fallahzadeh

Sadeghian

et al. 2021

BMC Cardiovasc Disord

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Background Despite several studies comparing off- and on-pump coronary artery bypass grafting (CABG), the effectiveness and outcomes of off-pump CABG still remain uncertain. Methods In this registry-based study, we assessed 8163 patients who underwent isolated CABG between 2014 and 2016. Propensity score matching (PSM), inverse probability of weighting (IPW) and covariate adjustment were performed to correct for and minimize selection bias. Results The overall mean age of the patients was 62 years, and 25.7% were women. Patients who underwent off-pump CABG had shorter length of hospitalization (p < 0.001), intubation time (p = 0.003) and length of ICU admission (p < 0.001). Off-pump CABG was associated with higher risk of 30-days mortality (OR: 1.7; 95% CI 1.09–2.65; p = 0.019) in unadjusted analysis. After covariate adjustment and matching (PSM and IPW), this difference was not statistically significant. After an average of 36.1 months follow-up, risk of MACCE and all-cause mortality didn’t have significant differences in both surgical methods by adjusting with IPW (HR: 1.03; 95% CI 0.87–1.24; p = 0.714; HR: 0.91; 95% CI 0.73–1.14; p = 578, respectively). Conclusion Off-pump and on-pump techniques have similar 30-day mortality (adjusted, PSM and IPW). Off-pump surgery is probably more cost-effective in short term; however, mid-term survival and MACCE trends in both surgical methods are comparable.

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“…8 -10 This occurs despite the use of the left internal thoracic artery, bypassing the left anterior descending artery (LAD), which supposes to improve the postoperative results and longevity after coronary artery bypass surgery. 11 Risk of operation in diabetic patients may increase because the coronary arteries are relatively small and diffusely diseased. [12][13][14][15] It is common knowledge that the coronary arteries in diabetic patients are heavily calcified and present difficulties during anastomosis.…”

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confidence: 99%

Can Surgeons Do Complete Revascularization in Diabetic Patients Using the Off-Pump Technique?

Arom

Jotisakulratana

Pitiguagool

et al. 2007

Innovations�(Phila)

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Background The arguments are discussed as to whether or not to proceed with multivessel percutaneous coronary intervention, with or without a drug-eluting stent, in patients with diabetes mellitus (DM), including (1) surgeons unable to complete revascularization because of smaller native arteries; and (2) diabetic patients being sicker and having higher operative mortality rates than nondiabetic patients (non-DM), particularly with the conventional coronary artery bypass surgery (on-pump) technique. To support or dispute the claims, a retrospective review of 480 consecutive patients at a single institution (195 DM and 285 non-DM) was carried out. Observations were made to see whether diabetes is a predictor of poor outcomes. Materials and Methods The preoperative comorbidity, intraoperative measurement of the size of the artery at the site of anastomosis with different gauged probes, and the number of grafts per patient were recorded. Intraoperative and postoperative variables between two groups were compared. The observed number of grafts (O) after surgery was compared with the number of grafts predicted (P) before surgery. The O/P ratio or “completion index” of ≥1 signifies complete revascularization. Logistic regression analysis was used to test the possibility that diabetes is a predictor of poor outcomes. Results Diabetic patients were older, with more comorbidity (congestive heart failure, peripheral vascular diseases, dialysis-dependent). The number of grafts per patient was 4.2 ± 1.3 (DM) and 4.2 ± 1.3 (non-DM). The size of 742 DM and 949 non-DM arteries were gauged. There was no statistical difference in size between DM and non-DM (in millimeters) at each artery. All ratios ranged from 0.9 to 1.2, indicating similarity between DM and non-DM. The only significant risk factor for operative death was low left ventricular ejection fraction (P = 0.001). Conclusions Patients with DM were sicker but tolerated off-pump coronary artery bypass grafting as well as non-DM patients. The number of grafts per patient and O/P ratio signify the ability to perform complete revascularization. We are able to bypass the small target vessels, as anticipated. Diabetes is not a predictor of the outcomes.

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Comparison of off-pump and on-pump coronary artery bypass grafting in midterm results

Abstract: Midterm clinical outcome in OPCAB is as good as conventional on-pump CABG. Incomplete revascularization caused cardiac events more frequently than complete revascularization both in OPCAB and on-pump CABG in the intermediate follow-up.

Cited by 7 publications

References 23 publications

Predictors of Mid-Term Symptom Recurrence, Adverse Cardiac Events and Mortality in 591 Unselected Off-Pump Coronary Artery Bypass Graft Patients

Predictors of Mid-Term Symptom Recurrence, Adverse Cardiac Events and Mortality in 591 Unselected Off-Pump Coronary Artery Bypass Graft Patients

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery; statistical challenges in comparison

Can Surgeons Do Complete Revascularization in Diabetic Patients Using the Off-Pump Technique?

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