Outcomes after Off-Pump Reoperative Coronary Artery Bypass Grafting

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Application of off-pump techniques to reoperative coronary artery bypass (redo CABG) has been limited by technical difficulty and potential for embolism of atheromatous debris from diseased grafts, resulting in myocardial infarction and rapid hemodynamic deterioration. We compared outcomes after off-pump (OPCAB) and on-pump (ONCAB) in redo CABG. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A retrospective chart review was performed for patients who underwent redo CABG at a single academic institution between January 1997 and December 2004. Outcomes were compared between groups based on intention to treat. Propensity scores were calculated for each patient using 23 preoperative risk factors. Logistic regression was applied for each end point as a function of group and propensity score. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> A total of 771 consecutive patients had redo CABG (639 ONCAB and 132 OPCAB); 22 patients (16.7%) were converted from OPCAB to ONCAB for hemodynamic in stability, severe adhesions, or graft injury; 7 patients (1.1%) were converted from ONCAB to OPCAB for severe aortic calcification. Propensity-matched comparison of outcomes after OPCAB versus ONCAB for redo CABG showed that OPCAB was associated with a reduction in postoperative complications, transfusion, atrial fibrillation, and length of stay. OPCAB patients received fewer grafts with similar use of left internal mammary artery conduit; conversion from OPCAB to ONCAB did not reduce the benefit of OPCAB. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> OPCAB can be safely and effectively applied to reoperative CABG in selected cases. </jats:p></jats:sec>

Off-pump coronary bypass surgery for high-risk patients: only in expert centers?

“…In a propensity-matched comparison of reoperative OPCAB versus ONCAB, Morris et al [31] reported a significant reduction in overall postoperative complications, atrial fibrillation, blood transfusion, and hospital LOS. Mishra et al similarly demonstrated a reduction in need for prolonged ventilator and inotropic support, and shorter ICU and hospital LOS in favor of redo OPCAB [32].…”

Does off-pump coronary revascularization confer superior organ protection in re-operative coronary artery surgery? A meta-analysis of observational studies

“…The incidence of post-operative atrial fibrillation was 5.05% in the OPCAB group and 13.8% in the ONCAB group, as reported by seven studies [10,12,14,16,17,20,21]. This reduction with OPCAB was statistically significant using the random effects model (OR 0.41; 95% CI 0.22-0.77) (Figure 7), without significant heterogeneity between the studies.…”

“…Of the 12 studies, five used cold blood cardioplegia [12,14-16,21], one used cold crystalloid [10], 2 used a combination of cold blood and cold crystalloid [11,20] and one study used a combination of cold blood, warm blood and hypothermic ventricular fibrillation [19]. The majority of studies (5/9) administered a combination of antegrade and retrograde cardioplegia [11,14,16,17,21]. Two studies used only an antegrade approach [19,20] and the remainder did not specify their technique.…”

“…Seven studies had a large sample size (≥50) in each cohort and were in this subgroup analysis [10,11,13,14,16,17,19]. …”

Off-pump coronary surgery: where do we stand in 2010?

“…However, Shroff and colleagues [24 ] reported only a modestly increased survival advantage for OPCAB patients. In patients with left-ventricular dysfunction [25,26], previous sternotomy [27], advanced age [27][28][29][30], previous stroke [31], and in female patients [32], more favorable outcomes have been reported with OPCAB compared with ONCAB. Emmert and associates [33 ] reported excellent outcomes in patients with left main disease undergoing OPCAB.…”