Total arterial revascularisation: effect of avoiding cardiopulmonary bypass on in-hospital mortality and morbidity in a propensity-matched cohort

Pandey, Ragini; Grayson, Antony D.; Pullan, D. Mark; Fabri, Brian M.; Dihmis, Walid C.
January 2005
European Journal of Cardio-Thoracic Surgery;Jan2005, Vol. 27 Issue 1, p94
Academic Journal
Abstract: Objective: The combination of total arterial revascularisation and avoidance of cardiopulmonary bypass may provide additional benefits to patients receiving complete arterial grafting with cardiopulmonary bypass. We performed a propensity-matched cohort study of complete arterial off-pump and on-pump coronary surgery and examined differences in in-hospital mortality and morbidity. Methods: Three hundred and sixty patients who underwent off-pump coronary surgery with complete arterial grafting between April 1997 and September 2002 were matched to 360 patients who received coronary surgery with cardiopulmonary bypass and complete arterial grafting. To match off-pump with unique on-pump patients, logistic regression was used to develop a propensity score for off-pump surgery. The C statistic for this model was 0.79. Off-pump patients were matched to unique on-pump patients with an identical 5-digit propensity score. If this could not be done, we then proceeded to a 4-, 3-, 2-, or 1-digit match. Results: Patient characteristics were well matched. There was no difference in in-hospital mortality between the groups. Off-pump patients were less likely to develop sternal wound infections compared to the on-pump group (2.5 versus 5.8%; P=0.03), and had significantly lower blood loss (675 versus 780ml; P<0.001), red blood cell unit transfusion (8.6 versus 38.9%; P<0.001), enzyme rises (13 versus 23U/l; P<0.001), inotrope support (11.9 versus 28.9%; P<0.001), and ventilation times (5 versus 8h; P<0.001). Intensive care unit and hospital stay were also significantly lower in the off-pump patients. Conclusions: Off-pump coronary surgery with complete arterial revascularisation can significantly reduce in-hospital morbidity and lengths of stay compared to conventional on-pump coronary surgery.


Related Articles

  • Myocardial revascularization with and without cardiopulmonary bypass: advantages, disadvantages and similarities Calafiore, Antonio Maria; Di Mauro, Michele; Canosa, Carlo; Di Giammarco, Gabriele; Iacò, Angela Lorena; Contini, Marco // European Journal of Cardio-Thoracic Surgery;Dec2003, Vol. 24 Issue 6, p953 

    Objectives: Off-pump coronary artery bypass surgery is becoming increasingly popular although its effectiveness remains controversial. Our goal was to investigate the effectiveness of on-pump and off-pump coronary artery bypass surgery on early (30 days) and long-term (5 years) clinical outcome...

  • OFF-PUMP CORONARY ARTERY BYPASS GRAFTING: A CASE REPORT. Behny, Leanne P. // AANA Journal;Feb2006, Vol. 74 Issue 1, p39 

    It is easy to take for granted the seemingly effortless way cardiovascular surgeons are able to bypass atherosclerotic coronary arteries. The process used today was developed over many years of rigorous study, experimentation, success, and failure. Early cardiac surgery was performed blindly,...

  • Cardiopulmonary Bypass during Cardiac Surgery Modulates Systemic Inflammation by Affecting Different Steps of the Leukocyte Recruitment Cascade. Rossaint, Jan; Berger, Christian; Van Aken, Hugo; Scheld, Hans H.; Zahn, Peter K.; Rukosujew, Andreas; Zarbock, Alexander; Schulz, Christian // PLoS ONE;Sep2012, Vol. 7 Issue 9, Special section p1 

    Background: It is known that the use of a cardiopulmonary bypass (CPB) during cardiac surgery leads to leukocyte activation and may, among other causes, induce organ dysfunction due to increased leukocyte recruitment into different organs. Leukocyte extravasation occurs in a cascade-like...

  • Lipopolysaccharide Binding Protein and sCD14 are Not Produced as Acute Phase Proteins in Cardiac Surgery. Kudlova, Manuela; Kunes, Pavel; Kolackova, Martina; Lonsky, Vladimir; Mandak, Jiri; Andrys, Ctirad; Jankovicova, Karolina; Krejsek, Jan // Mediators of Inflammation;2007, Vol. 2007, Special section p1 

    Objectives. The changes in the serum levels of lipopolysaccharide binding protein (LBP) and sCD14 during cardiac surgery were followed in this study. Design. Thirty-four patients, 17 in each group, were randomly assigned to coronary artery bypass grafting surgery performed either with...

  • Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve Song, Howard K.; Petersen, Rebecca J.; Sharoni, Erez; Guyton, Robert A.; Puskas, John D. // European Journal of Cardio-Thoracic Surgery;Dec2003, Vol. 24 Issue 6, p947 

    Objective: Off-pump coronary artery bypass (OPCAB) hopes to avoid morbidity associated with cardiopulmonary bypass, improving clinical outcomes. Yet its technical difficulty and unfamiliarity raise concern that adoption of OPCAB might be associated with poorer outcomes during each surgeon''s...

  • THE EFFECTS OF METHYLPREDNISOLONE ON THE COMPLICATIONS OF CORONARY ARTERY SURGERY. Rao, G.; King, J.; Ford, W.; King, G. // Vascular Surgery;Jan/Feb1977, Vol. 11 Issue 1, p1 

    Complications of coronary artery surgery were analyzed in a prospective controlled study of 150 patients, one group receiving methylprednisolone before temporary cardiopulmonary bypass. The patient population was comparable in both the groups. The number of deaths were the same in both the...

  • Off-Pump Coronary Artery Bypass Is an Alternative to Conventional Cardiopulmonary Bypass When Repair of Traumatic Coronary Artery Injuries Is Indicated. Moore, Forrest O.; Berne, John D.; Turner, William F.; Villarreal, David H.; McGovern, Thomas; Rowe, Stephen A.; Norwood, Scott H. // American Surgeon;Mar2007, Vol. 73 Issue 3, p296 

    Coronary artery injuries after penetrating cardiac trauma are rare. The standard approach to these injuries has traditionally been coronary artery ligation. When cardiac perfusion is profoundly compromised, cardiopulmonary bypass has been used to facilitate revascularization, although with...

  • Influence of pericardial suction blood retransfusion on memory function and release of protein S100B. Svenmarker, S.; Engström, K.G.; Karlsson, T.; Jansson, E.; Lindholm, R.; Åberg, T. // Perfusion;Nov2004, Vol. 19 Issue 6, p337 

    Background: To study the influence of pericardial suction blood (PSB) on postoperative memory disturbances and release patterns of protein S100B during and after cardiopulmonary bypass (CPB). Methods: Sixty male patients admitted for coronary artery bypass surgery were prospectively randomized...

  • Comparison of gastrointestinal complications in on-pump versus off-pump coronary artery bypass grafting. Croome, Kris P.; Kiaii, Bob; Fox, Stephanie; Quantz, Mackenzie; McKenzie, Neil; Novick, Richard J. // Canadian Journal of Surgery;Apr2009, Vol. 52 Issue 2, p125 

    Background: Gastrointestinal (GI) complications following coronary artery bypass grafting (CABG), although infrequent, are associated with significant morbidity and mortality. It has been suggested that systemic inflammatory response plays an important role in these complications....


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics