Propensity Case-Matched Analysis of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting in Patients With Atheromatous Aorta

Mishra, Manisha; Malhotra, Rajneesh; Karlekar, Anil; Mishra, Yugal; Trehan, Naresh

doi:10.1016/j.athoracsur.2006.03.071

Cited by 46 publications

(25 citation statements)

References 32 publications

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“…Ascione and Angelini (5) discussed the dilemma faced by many cardiac surgeons who perform CABG. On one hand, the literature is replete with studies that emphasize the potential for reducing postoperative morbidity and length of stay with OPCAB surgery (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24); on the other hand, there is continued concern regarding intraoperative myocardial ischemia, inadequate revascularization and the need for early revascularization (5,8,23,(25)(26)(27)(28)(29).…”

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confidence: 99%

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Ivanov

Borger

et al. 2008

Canadian Journal of Cardiology

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C oronary artery disease is associated with more death and disabilities than any other disease in industrialized nations. Coronary artery bypass graft surgery (CABG) is one of the most effective methods of treating symptomatic coronary artery disease and is performed in approximately 10,000 patients annually in Ontario.The majority of cardiac operations require the establishment of cardiopulmonary bypass and cardioplegic arrest. However, cardiopulmonary bypass is a well-recognized factor for generating a whole-body inflammatory response, which can contribute to postoperative morbidity including renal, pulmonary, neurological and bleeding complications (1,2). Benetti et al (3) and Buffolo et al (4) reintroduced beating heart surgery almost 20 years ago as a strategy to prevent complications in high-risk patients. Since that time, off-pump coronary artery bypass (OPCAB) surgery has gained increasing popularity and is challenging conventional on-pump coronary artery bypass (CCAB) as the standard of therapy for multivessel disease in many cardiac centres (2).The benefits of OPCAB remain controversial, despite the publication of numerous studies reporting equivalent or improved hospital outcomes and significantly shorter lengths of hospital stay. Ascione and Angelini (5) discussed the dilemma faced by many cardiac surgeons who perform CABG. On one hand, the literature is replete with studies that emphasize the potential for reducing postoperative morbidity and length of stay with OPCAB surgery (6-24); on the other hand, there is continued concern regarding intraoperative myocardial ischemia, inadequate revascularization and the need for early revascularization (5,8,23,(25)(26)(27)(28)(29).Therefore, the purpose of the present study was to evaluate midterm outcomes of OPCAB versus conventional CCAB in two wellmatched cohorts. CLINICAL STUDIES©2008 Pulsus Group Inc. All rights reserved OBJECTIVE: To evaluate survival and readmissions to hospital for cardiac events or coronary revascularization (REVASC) in patients having off-pump (OPCAB) versus conventional on-pump (CCAB) coronary artery bypass graft surgery (CABG). METHODS: Of 11,368 consecutive patients undergoing isolated CABG between 1996 and 2002, 514 had OPCAB surgery. Using propensity scores, 503 CCAB patients were randomly matched to 503 OPCAB patients. RESULTS: There were no clinical or statistical differences between the two groups for any prognostic variable. However, OPCAB patients received significantly fewer distal anastomoses than the CCAB group (2.6±1.0 versus 3.1±1.0; P<0.001). There was no difference in operative mortality (OPCAB 1.0%, CCAB 1.4%; P=0.6), but the OPCAB group had significantly fewer operative strokes (0.2% versus 1.8%; P=0.01). Follow-up was 99.7% complete at 2.2±1.2 years (range 0 to 6 years). Twice as many OPCAB patients (n=24) required REVASC compared with the CCAB (n=11) group. The following five-year actuarial outcomes are presented for CCAB and OPCAB, respectively: survival: 77±6%, 76±8%, P=0.8; freedom from REVASC: 95±3%, 92±2%, ...

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confidence: 99%

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Ivanov

Borger

et al. 2008

Canadian Journal of Cardiology

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“…Other studies that compare OPCAB and conventional CABG also show that use of OPCAB in patients with severe atheromatous aortic disease is associated with significantly lower mortality, perioperative stroke, and overall complications. 12,13) A recent case-matched report demonstrated a hospital survival benefit in specific high-risk OPCAB patients. 13) These findings are consistent with our outcomes.…”

Section: Discussionmentioning

confidence: 99%

Improve Morbidity and Mortality in Coronary Artery Bypass Graft Surgery for Severe Atherosclerosis

Kanemitsu

Tanabe

Ohue

et al. 2011

Annals of Vascular Diseases

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Objectives: Atherosclerosis has been identified as a risk factor for both morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG). To investigate outcomes following CABG for severe atherosclerosis, and to determine whether different surgical techniques can reduce the risk of neurologic events in these patients. Methods: We studied 225 consecutive patients who underwent elective isolated CABG. Routine preoperative and intraoperative examinations identified patients with severe atherosclerosis. We compared the outcomes between patients with (group A; 42 ceses) and those without (group N; 183 cases) severe atherosclerosis. Results: 36 patients (85.7%) in group A and 176 (96.2%) in group N underwent off-pump coronary artery bypass (OPCAB); 6 (14.3%) in group A and 7 (3.8%) in group N underwent on-pump beating CABG. Three patients in group A suffered deep sternal infection (7.1%), and one suffered stroke (2.4%) compared with none in group N. No cerebral infarction or neurologic events occurred in patients who underwent OPCAB (n = 212, 94.2%). Conclusions: Prevalence of complications was significantly greater among patients with severe atherosclerotic disease who underwent OPCAB than in those without atherosclerotic disease. Careful selection of surgical strategies can prevent perioperative stroke and reduce mortality.

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“…A large single‐center study utilizing propensity‐matched analysis in patients with atheromatous disease of the ascending aorta associated ONCAB with an increased risk of postoperative stroke (OR: 1.4; P =0.05) and operative mortality 68. Another study associated OPCAB with reduced stroke and operative mortality in a similar population 69.…”

Section: Opcab In Specific Subsets Of Patientsmentioning

confidence: 99%

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

Gaudino

Angelini

Antoniades

et al. 2018

JAHA

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Propensity Case-Matched Analysis of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting in Patients With Atheromatous Aorta

Cited by 46 publications

References 32 publications

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Improve Morbidity and Mortality in Coronary Artery Bypass Graft Surgery for Severe Atherosclerosis

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

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