Off-Pump Bypass Surgery—Ready for the Big Dance?

Peterson, Eric D.; Mark, Daniel B.

doi:10.1001/jama.291.15.1897

Cited by 18 publications

(10 citation statements)

References 13 publications

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“…Clearly, this should involve acting on recommendations to launch large RCTs of OPCAB and on-pump CABG surgery. 45 However, unlike trials of devices for which the results are unaffected by surgical skill, it will also be important to account for the expertise of surgeons and its interaction with choice of procedure.…”

Section: Hannan Et Almentioning

confidence: 99%

Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery

et al. 2007

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Background-Off-pump coronary artery bypass graft surgery (OPCAB) has been performed for many years, but its use is increasing in frequency, and it remains an open question whether OPCAB is associated with better outcomes than on-pump coronary artery bypass graft (CABG) surgery. In the matched samples, no difference existed in 3-year mortality (hazard ratio 1.08, 95% CI 0.96 to 1.22), but OPCAB patients had higher rates of subsequent revascularization (hazard ratio 1.55, 95% CI 1.33 to 1.80). The 3-year OPCAB and on-pump survival rates for matched patients were 89. 4% and 90.1%, respectively (Pϭ0.20). For freedom from subsequent revascularization, the respective rates were 89.9% and 93.6% (PϽ0.0001). Conclusions-OPCAB is associated with lower in-hospital mortality and complication rates than on-pump CABG, but long-term outcomes are comparable, except for freedom from revascularization, which favors on-pump CABG. Methods and Results-New

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Section: Hannan Et Almentioning

confidence: 99%

Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery

et al. 2007

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Section: Discussionmentioning

confidence: 99%

“…An ever increasing number of retrospective studies and a few randomized studies have been published which clearly show the benefits of OPCAB. Most of these papers underscore the results on hospital mortality, the possibility of total revascularization using arterial conduits and the incidence of stroke, loss of cognitive function, impairment of renal function, less morbidity and shorter hospital stay, all of these results according to gender [6][7].A multicentric study of 17,969 patients undergoing offpump surgery from the database of the American Association for Thoracic Surgery (AATS) assessed retrospectively and by statistical analysis to obtain groups with comparable risk factors (with or without cardiopulmonary bypass), showed lower in-hospital mortality in the off-pump group undergoing total revascularization [8]. MACK et al, in a study of 7,283 patients undergoing off-pump coronary bypass, showed that the use of cardiopulmonary bypass in patients over 75 years of age was a predictor for greater risk of mortality (OR 2.13 CI 95% 1.20-3.76, p= 0.01) [9].…”

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confidence: 99%

<![CDATA[<B>Off-pump coronary artery bypass with multiple arterial conduits</B>]]>

Navia¹,

Vrancic²,

Vaccarino³

et al. 2005

Braz. j. cardiovasc. surg.

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Objective: to analyze intra-hospital results in patients undergoing elective off-pump total arterial revascularization and identify morbidity and mortality predictors using this surgical strategy.Methods: From May 1999 to February 2004, 203 myocardial revascularization procedures with total arterial revascularization without cardiopulmonary bypass (off-pump) were carried out in patients with multivessel disease (three vessels 81.7 %, one vessel disease was excluded). We report pre-surgical variables and co-morbidities: average age 63.9 ± ± ± ± ± 9.13 years, men 182 (89.5%), hypertension 132 (65%), smokers 125 (61%), hypercholesterolemia 152 (74.8%), previous myocardial infarction (> 30 days) 73 (35%), moderate to severe ventricular dysfunction 31 (15%), redo 5 (2.5%). Total arterial revascularization included T-grafts and sequential grafts with left internal mammary (100%), right internal mammary (56.6%) and radial (63%) arteries. The total number of distal anastomosis was 576 (mean of 3 grafts/patient), all carried out with external mechanical stabilizers. There were no proximal aortic anastomoses. Conversion to on-pump surgery occurred in 3 patients (1.5%). 90% of the patients was extubated in the operating room. The multiple logistic regression test was used for statistical analysis.Results: The postoperative incidence of atrial fibrillation was 12.8% (26), oligoanuric renal failure 3% (6), dialysis 0.49% (1), postoperative myocardial infarction 1.47% (3), low cardiac output 4% (8), Redo for bleeding 1.47% (3), mediastinitis 1.47% (3), stroke 1.47% (3). Intra-hospital mortality was 2.45% (5). The only independent 30 day morbidity predictor was age (p=0.033; OR 1.04; IC 95%: 1-1.08).Conclusion: Off-pump myocardial revascularization with arterial conduits for multiple vessel disease is feasible with a low 30-day morbidity and mortality.Descriptors: Coronary surgery. Off-pump circulation. Multiple vessel disease. Arterial conduits Cirurgia coronária com condutos arteriais múltiplos sem circulação extracorpóreaOff-pump coronary artery bypass with multiple arterial conduits 40 NAVIA, D ET AL -Off-pump coronary artery bypass with multiple arterial conduits Braz J Cardiovasc Surg 2005; 20(1): 39-45 INTRODUCTIONThe use of cardiopulmonary bypass (CPB) by heart surgeons over the last 35 years has enabled coronary artery bypass grafting in more complex patients with higher surgical risk giving better results. Nevertheless, its use is associated to a certain degree of morbidity and in some clinical situations to a higher incidence of post-surgical morbidity and mortality. The undesirable effects of cardiopulmonary bypass are expressed as physiological disorders secondary to the exposure of blood to plastic tubes, oxygenators and filters, which, combined with the use of surgical field aspirators, destroy red and white blood cells and platelets. Likewise, it has been shown that this activates the inflammatory system with the release of cytokines and the increase of capillary patency and the potential threat to ...

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“…The use of the cardiopulmonary bypass is, however, believed by many cardiac surgeons to be associated with serious complications, including cognitive deficits, stroke, renal failure, and pulmonary dysfunction. 10 Off-pump surgery, which is performed on the beating heart without the use of the cardiopulmonary bypass, 11 was reintroduced in the late 1990s because many cardiac surgeons believed it may decrease the incidence of complications. 10 …”

Section: Introductionmentioning

confidence: 99%

Racial variations in the choice of on-pump versus off-pump coronary artery bypass grafting

Mukamel

Glance

Weimer

et al. 2007

J Health Serv Res Policy

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Objective-To examine explanations of differences in utilization rates of a newly reintroduced technique -off-pump coronary artery bypass grafting (CABG) -between racial minorities and Whites.Method-The study was based on 15,313 CABG patients in the New York State Cardiac Surgery Reporting System covering all cardiac surgeons providing off-pump CABG in New York State. We estimated cross sectional, random effect regression models predicting the probability of offpump versus on-pump surgery.Results-Thirty one percent of Blacks, 20.7% of other races, and 23% of Whites underwent offpump CABG (P < 0.0001). The higher rates for Blacks arose mostly from being treated by surgeons performing only a few off-pump procedures rather than from surgeons performing many off-pump surgeries. After adjusting for clinical characteristics and coronary anatomy, Blacks

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Off-Pump Bypass Surgery—Ready for the Big Dance?

Cited by 18 publications

References 13 publications

Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery

Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery

<![CDATA[<B>Off-pump coronary artery bypass with multiple arterial conduits</B>]]>

Racial variations in the choice of on-pump versus off-pump coronary artery bypass grafting

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