Current Practice and Outcomes of Off-pump Multivessel Coronary Artery Bypass

2009 ◽  
Vol 17 (4) ◽  
pp. 362-367
Author(s):  
Xiumei Sun ◽  
Roger Michael Lim ◽  
Peter C Hill ◽  
Elizabeth Haile ◽  
Paul J Corso ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Current Practice ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Ventilatory Support ◽  
Perioperative Myocardial Infarction ◽  
Off Pump ◽  
Hospital Stays ◽  
Pump Coronary Artery Bypass

Outcomes of off-pump multivessel coronary artery bypass were compared with those of the on-pump procedure. From July 2001 to June 2006, 3,637 patients with multivessel coronary disease underwent off-pump coronary artery bypass, and 3,586 patients had on-pump coronary artery bypass in our center. The rates of operative mortality, permanent stroke, renal failure and perioperative myocardial infarction were significantly lower in the off-pump group, and these patients required fewer blood transfusions, shorter durations of ventilatory support, and shorter hospital stays. However, the patients who underwent on-pump coronary artery bypass were considered more high-risk and tended to have more complex procedures.

scholarly journals Aborted Off-Pump Coronary Artery Bypass Patients Have Much Worse Outcomes Than On-Pump or Successful Off-Pump Patients

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Ruyun Jin ◽  
Loren F. Hiratzka ◽  
Gary L. Grunkemeier ◽  
Albert Krause ◽  
U. Scott Page
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Operative Mortality ◽  
Risk Model ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Left Ventricular ◽  
Mortality And Morbidity ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

Background— Off-pump coronary artery bypass graft (CABG) surgery is purported to reduce perioperative mortality and morbidity compared with on-pump coronary bypass graft surgery. However, the outcomes of patients for whom an off-pump strategy must be changed to an on-pump procedure during surgery have not been extensively studied. Methods and Results— The Merged Cardiac Registry (Health Data Research, Inc) contains 70 514 isolated CABG performed from January 1998 to March 2004 in 40 facilities. Among them, 62 634 patients begun and completed on-pump bypass (CPB); 7880 patients begun off-pump, of which 7424 (94.2%) completed off-pump coronary artery bypass (OPCAB), whereas 456 (5.8%) were converted to on-pump (CONVERT). CONVERT patients were more severely ill. The observed mortality of CONVERT, CPB, and OPCAB was 9.9%, 3.0%, and 1.6%, respectively, and the observed-to-predicted ratio was 2.77, 1.20, and 0.74, respectively. CONVERT also had more morbidity than either OPCAB or CPB. Finally, a risk model was created to identify patients who might be at risk for conversion from off-pump to on-pump CABG. Conclusions— Patients who are intended for an off-pump strategy and then require conversion to on-pump have significantly higher operative mortality and morbidity than either completed OPCAB or CPB patients. In addition, the operative mortality and morbidity are far in excess of that predicted preoperatively. Based on these results, strong consideration should be given for a planned strategy of CPB for those patients with preoperative hemodynamic instability requiring a salvage CABG operation, left ventricular hypertrophy, or previous CABG.

Off-Pump Coronary Artery Bypass Grafting is Associated with Reduced Operative Mortality and In-Hospital Adverse Events in Patients with Left Main Coronary Artery Disease

2009 ◽  
Vol 4 (2) ◽  
pp. 80-85 ◽  
Author(s):  
Eric L. Sarin ◽  
John D. Puskas ◽  
Patrick D. Kilgo ◽  
Vinod H. Thourani ◽  
Robert A. Guyton ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Operative Mortality ◽  
Left Main Coronary Artery ◽  
Artery Bypass ◽  
Left Main ◽  
Off Pump ◽  
Main Coronary Artery Disease ◽  
Artery Disease ◽  
Pump Coronary Artery Bypass

Objective Left main coronary artery disease (LMD) is a known risk factor for perioperative complications. This study compares off-pump coronary artery bypass (OPCAB) versus on-pump coronary artery bypass (ONCAB) grafting, CABG, with respect to in-hospital death, stroke, myocardial infarction, and major adverse cardiac events (MACE) in CABG patients with and without LMD. Methods Among 13,108 consecutive isolated patients with CABG treated from 1997 to 2007, 2891 patients (22.1%) were preoperatively found to have LMD. Of 5917 patients with OPCAB, 1276 (21.6%) had LMD, whereas among patients with ONCAB, 1615 of 7191 (22.5%) had LMD. Surgery type, LMD, and their interaction were examined for their impact on operative mortality, stroke, myocardial infarction, and MACE via multiple logistic regression models and adjusted odds ratios (AOR). Results Utilization of OPCAB for coronary revascularization in patients with LMD disease gradually increased from an initial low of 1.3% of patients in 1997 to a peak of 80.8% in 2007. OPCAB was associated with reduced incidence of stroke (AOR = 0.51, P < 0.001) and MACE (AOR = 0.66, P = 0.002), whereas LMD was associated with an increased incidence of MACE (AOR = 1.24, P = 0.038). No interactions between surgery type and LMD existed, meaning that the 2 conditions did not combine in any way to modify outcomes. Conclusions Patients with LMD are more likely to suffer a MACE event than those without LMD. Off-pump coronary artery bypass grafting is marginally associated with lesser risk of operative mortality and significantly associated with less stroke and overall MACE when compared with ONCAB. This benefit of OPCAB is similar for patients with and without LMD.

scholarly journals Reduced Mortality and Strokes With Off-Pump Coronary Artery Bypass Grafting Surgery in Octogenarians

Circulation ◽  
2002 ◽  
Vol 106 (12_suppl_1) ◽  
Author(s):  
Roland G. Demaria ◽  
Michel Carrier ◽  
Simon Fortier ◽  
Raymond Martineau ◽  
Annick Fortier ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Opcab Group ◽  
Significant Difference ◽  
Pump Coronary Artery Bypass

Background Off-pump coronary artery bypass surgery (OPCAB) has been revived and has gained popularity, although the exact subsets of patients who might benefit most from this technique are unknown. The aim of this retrospective study was to compare the results of coronary artery bypass grafting surgery (CABG) in octogenarians using cardiopulmonary bypass (CPB) or OPCAB techniques. Methods and Results Over a 5-year period (1995–1999), 125 patients older than 80 years of age were operated for isolated myocardial revascularization (63 using CPB and 62 with OPCAB). There was no statistically significant difference in preoperative comorbidities between groups or in mean left ventricular ejection fraction (54.5±15.3% in the CPB group and 50.9±13.5% in the OPCAB group, respectively). The mean number of distal anastomosis per patient was 2.9 in CPB group and 2.6 in OPCAB group ( P =ns). The majority of patients in both groups had unstable angina and were operated on an urgent basis. The operative mortality was 15.9% in the CPB group and 4.8% in the OPCAB group ( P =0.04). There were 4 postoperative strokes (6.3%) in the CPB group and none (0%) in the OPCAB group ( P =0.04). The percentage of patients transfused was 92.1% in the CPB group and 72.6% in the OPCAB group ( P <0.01). Postoperative myocardial infarction occurred in 11.3% in the CPB group and 14.5% in the OPCAB group ( P =NS). For all the parameters entered in the multivariate analysis with logistic regression model, the type of surgery (CPB or OPCAB) was an independent predictor of operative mortality and stroke ( P =0.0375). The odds ratio (OR) indicates that operative mortality and stroke occur 4 times (OR=4.171) more often in CPB patients than in OPCAB patients. Follow-up showed no significant difference between the 2 groups in terms of cardiac events and mortality. Conclusions This retrospective study suggests a benefit of OPCAB in terms of operative mortality and stroke for octogenarian patients when compared with CPB in our institution.

Concomitant Off-Pump Coronary Artery Bypass Grafting Results in Improved In-Hospital Outcomes for Patients with Ischemic Mitral Regurgitation Undergoing Surgery

2013 ◽  
Vol 16 (1) ◽  
pp. 15 ◽  
Author(s):  
Shahzad G. Raja ◽  
Mubassher Husain ◽  
Kareem Salhiyyah ◽  
Manoraj Navaratnarajah ◽  
Dimple Chudasama ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Valve Repair ◽  
Hospital Outcomes ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

<p><b>Objective:</b> Surgical management of ischemic mitral regurgitation (IMR) has primarily consisted of revascularization with or without the addition of mitral valve repair or replacement. We hypothesize that performing off-pump coronary artery bypass (OPCAB) grafting before fixing MR improves in-hospital outcomes for patients with IMR undergoing surgery.</p><p><b>Methods:</b> From January 2000 through December 2010, a total of 96 consecutive patients with moderate or severe IMR, as determined by preoperative echocardiography, underwent on-pump coronary artery bypass grafting (CABG) (n = 66) or OPCAB (n = 30) revascularization with concomitant mitral valve repair or replacement. A retrospective analysis of a prospectively collected cardiac surgery database (PATS; Dendrite Clinical Systems, Oxford, UK) was performed. In addition, medical notes and charts were reviewed for all study patients.</p><p><b>Results:</b> The 2 groups had similar preoperative demographic and EuroSCORE risk-stratification characteristics. The operative mortality rate for the entire cohort was 9.4%. Patients who underwent OPCAB grafting had a lower operative mortality than those who underwent CABG (3.3% versus 12.1%; <i>P</i> = .006). The mean �SD cardiopulmonary bypass time (82.7 � 34.7 minutes versus 160.7 � 45.2 minutes; <i>P</i> < .001) and cross-clamp time (49.0 � 22.4 minutes versus 103.4 � 39.5 minutes; <i>P</i> < .001) were significantly shorter in the off-pump group than in the on-pump group. The OPCAB group also had significantly less in-hospital morbidity and shorter stays in the intensive care unit and the hospital.</p><p><b>Conclusion:</b> Our analysis shows that OPCAB grafting (compared with conventional CABG) before repairing MR is associated with favorable in-hospital outcomes for patients undergoing surgery for IMR.</p>

Abstract 2885: Clinical Profiles of Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery: The California Coronary Artery Bypass Graft Surgery Outcomes Reporting Program

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Zhongmin Li ◽  
Khung-Keong Yeo ◽  
Geeta Mahendra ◽  
Ezra A Amsterdam
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Volume Ratio ◽  
Artery Bypass Graft ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

Objective: To compare the clinical and procedural characteristics, and operative mortality in patients undergoing off-pump coronary artery bypass surgery (OPCAB) and conventional coronary bypass surgery (CCB) among California hospitals, using data from the 2003 and 2004 California Coronary Artery Bypass Graft Surgery (CABG) Outcomes Reporting Program (CCORP). Methods: State mandated data from 121 hospitals that performed isolated CABG during 2003 and 2004 were analyzed, excluding patients with emergent or prior CABG. Patient characteristics associated with OPCAB were identified by multivariate logistic regression analysis. Predicted mortality was calculated using a multivariate model. Correlation between hospital OPCAB volume, OPCAB/CCB volume ratio and hospital risk-adjusted mortality rates was assessed. Results: OPCAB comprised 23% (8,139) of all isolated CABGs, with significant variation in volume among hospitals (median: 29; range 0–1,065). OPCAB was less likely in Caucasians compared with non-Caucasians (adjusted odds ratio [AOR]=0.85, 0.80–0.90), diabetics compared with nondiabetics (AOR 0.93, 0.87–0.98), those with myocardial infarction (MI) 1–7 days prior to CABG compared to no MI (AOR 0.87, 0.81–0.94), and in patients with ≥3 diseased vessels compared with 1 or 2-vessel disease (AOR 0.46, 0.44–0.49). However, OPCAB was more likely in those with peripheral arterial disease (PAD) compared with no PAD (AOR 1.16, 1.07–1.25), or cerebrovascular disease (CVD) compared with no CVD (AOR 1.14 1.03–1.26). OPCAB was associated with a significantly lower risk for observed operative mortality compared with CCB (1.84% vs. 2.49%, p<0.0001), which persisted after adjustment for 23 preoperative factors associated with operative mortality (AOR 0.67, p<0.0001). However, neither hospital OPCAB volume nor OPCAB/CCB volume ratio were associated with hospital risk adjusted operative mortality (p=0.324 and p=0.547, respectively.) Conclusion: OPCAB patients had generally better risk profiles associated with their lower predicted and observed operative mortality. But OPCAB results had no significant impact on hospital level risk-adjusted operative mortality.

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