Conversion From Off-Pump Coronary Artery Bypass Grafting to On-Pump Coronary Artery Bypass Grafting

Keeling, Brent; Thourani, Vinod H.; Aliawadi, Gorav; Kim, Sunghee; Cyr, Derek D.; Badhwar, Vinay; Jacobs, Jeff; Brennan, James M.; Meza, James M.; Matsouaka, Roland; Halkos, Michael E.

doi:10.1016/j.athoracsur.2017.03.032

Cited by 34 publications

(28 citation statements)

References 20 publications

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“…Arrhythmias and hypotension were two conditions observed causing conversions. In a recent analysis of STS Adult Cardiac Surgery Database (ACSD) involving over 196,000 patients reported that the conversion rate was 5.5% of which 50% were elective [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Conversion from Off to On-Pump Coronary Artery Bypass Grafting. Is it Avoidable?

Tariq¹,

Zia²,

Mangi³

et al. 2020

Cureus

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Section: Discussionmentioning

confidence: 99%

Conversion from Off to On-Pump Coronary Artery Bypass Grafting. Is it Avoidable?

Tariq¹,

Zia²,

Mangi³

et al. 2020

Cureus

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“…In the previously cited meta‐analysis, emergency conversion raised the OR of mortality to 6.99 (95% CI, 5.18–9.45) 98. In addition to the noted increased mortality, IOC is also associated with increased risk of almost all perioperative complications including myocardial ischemic injury, stroke, renal failure, and prolonged ventilation 97, 100, 101. Furthermore, IOC is associated with increased costs102 as well as hospital readmissions and infectious complications 103.…”

Section: Intraoperative Conversion From Off‐pump To On‐pumpmentioning

confidence: 98%

“…In an analysis based on the STS ACSD, Keeling et al97 reported observed to expected mortality of 1.4 for an elective IOC, 1.6 for emergency IOC for visualization reasons, and 2.7 for emergency IOC for hemodynamic instability. In the previously cited meta‐analysis, emergency conversion raised the OR of mortality to 6.99 (95% CI, 5.18–9.45) 98.…”

Section: Intraoperative Conversion From Off‐pump To On‐pumpmentioning

confidence: 99%

“…Keeling et al97 showed that older age, EF <35%, preoperative need for intra‐aortic balloon pump, increasing number of diseased native coronary vessels, history of congestive heart failure, and urgent status of surgery are all independent predictors of IOC. Other identified risk factors for IOC are left main coronary artery disease, intramyocardial course of coronary targets, reoperative procedures, and increasing number of coronary grafts constructed 99, 100, 105…”

Section: Intraoperative Conversion From Off‐pump To On‐pumpmentioning

confidence: 99%

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Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

Gaudino

Angelini

Antoniades

et al. 2018

JAHA

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“…In the Society of Thoracic Surgeons database, the conversion rate for 196,000 patients was 5.5%, of which 50% were elective. 18 In the Randomized On/Off Bypass (ROOBY) trial, 11 the rate of conversion was 12.5% (surgeons took part regardless of their experience, and 55% of the procedures were performed by surgeons in training). Even in the CABG Off or On Pump Revascularization Study (CORONARY) trial, 10 in which surgeons were required to have performed 100 OPCAB procedures before been allowed to recruit, the conversion rate was 7.9%.…”

Section: Opcab: For the Many Or The Few?mentioning

confidence: 99%

An old off-pump coronary artery bypass surgeon's reflections: A retrospective

Angelini

2019

The Journal of Thoracic and Cardiovascular Surgery

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In 2010, at the height of the off-pump coronary artery bypass (OPCAB) surgery controversy, I wrote an editorial for this Journal with one of my trainees, the goal of which was critically to evaluate the status of the technique and its future direction. 1 We concluded that OPCAB was a safe alternative to on-pump coronary artery bypass (ONCAB) surgery and that, with proper structured training and supervision and in the right environment, OPCAB was a technique ''for the many and not the few.'' After practicing OPCAB for 25 years, I am reaching the twilight of my surgical career. From this perspective, I reflect on this experience and offer some insights that I hope will be of help to the surgical community, particularly to the young surgeons in training. EARLY STAGE DEVELOPMENTWith colleagues, my journey started in 1994, when the aim was to emulate our fellow general surgeons practicing minimally invasive surgery. The goal was to revascularize the left anterior descending coronary artery with the left internal thoracic artery through a left anterior small thoracotomy. 2 By default, the restricted access led to the surgery being performed on the beating heart. Although I had practiced endoscopic thoracic surgery during my training, I was not accustomed to working in a confined space, and this, combined with the lack of dedicated instruments, sometimes made the surgery impossible.To increase the proportion of patients to whom a left anterior small thoracotomy could be applied, the hybrid approach was devised with percutaneous coronary intervention with or without stenting. 2 The simultaneous combination, however, which required using anticoagulation after stenting, was often followed by bleeding from the surgical site. Carrying out percutaneous coronary intervention before surgery did not allow the quality of the surgery to be checked. Percutaneous coronary intervention a few days after surgery did not help in the event of a problem with the left internal thoracic artery-left anterior descending anastomosis. Furthermore, most health service providers charged for 2 separate procedures, with a significant increase in costs.We soon realized that to revascularize all the ischemic areas of the heart, we had to go back to the experience of surgeons like Buffalo and Benetti in the late 1980s; that is, beating-heart coronary surgery through a median sternotomy. 3 Ironically, this rejected the quest for a minimally invasive approach and instead prioritized the perceived benefits of avoiding cardiopulmonary bypass (CPB) (Figure 1).In our institution, a dedicated group including anesthetists, nurses, and surgeons embarked on a structured program that resulted in an increase in OPCAB from 8% of CABG operations in 1997 to 72% in 2003, without any increase in procedural morbidity. In relation to the learning curve, after 100 OPCAB operations, performance was the same or better for the residents in training as for me, the senior consultant. For all surgeons, performance was the same as or better than OPCAB than ONCAB grafting. 4 Alo...

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Conversion From Off-Pump Coronary Artery Bypass Grafting to On-Pump Coronary Artery Bypass Grafting

Abstract: Intraoperative conversion from OPCAB to ONCAB remains a morbid event with a risk of mortality much higher than expected. Surgeons should consider elective ONCAB in those with a high risk for conversion during OPCAB.

Cited by 34 publications

References 20 publications

Conversion from Off to On-Pump Coronary Artery Bypass Grafting. Is it Avoidable?

Conversion from Off to On-Pump Coronary Artery Bypass Grafting. Is it Avoidable?

Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

An old off-pump coronary artery bypass surgeon's reflections: A retrospective

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