Mortality risk factors from converting off-pump coronary artery bypass to on-pump coronary artery bypass

Abstract

Introduction:

A number of large-scale retrospective studies revealed that off-pump coronary artery bypass (OPCAB) was superior to on-pump coronary artery bypass (ONCAB). The aim of the study was to investigate risk factors for mortality when OPCAB is converted to ONCAB.

Methods:

Patients who underwent OPCAB conversion to ONCAB at the Beijing Anzhen Hospital between January 2003 and January 2013 were assigned to the non-survivor and survivor groups. Background demographics, illness history and preoperative, intraoperative and postoperative variables were compared.

Results:

Of the 247 cases, 15.4% of the patients died. Patients in the non-survivor group were older and more frequently had diabetes mellitus (DM), arrhythmia, myocardial infarction (MI) in the past 30 days (all p<0.05) and MI combined with mitral regurgitation (p<0.0001); they more frequently had bigger left ventricular end-diastolic dimension (p=0.0019), greater fall in blood pressure, ventricular fibrillation for longer periods, longer conversion time and bypass graft occlusion. All patients in the non-survivor group received intra-aortic balloon pump compared to 89.5% in the survivor group and extracorporeal membrane oxygenation was more common. Left main coronary artery disease (OR=4.431, 95%CI: 2.440-8.048, p<0.0001), blood pressure decline ⩽40 mmHg (OR=0.509, 95%CI: 0.447-0.580, p<0.0001) and time for conversion to ONCAB ⩾20 min were independently associated with mortality. Rates of postoperative complications, such as renal failure, cerebral infarction or hemorrhage, MI and redo sternotomy, were higher in the non-survivor group.

Conclusions:

Conversion from OPCAB to ONCAB is associated with high mortality. Risk factors include left main artery disease and duration of blood pressure decline >40 min.

Keywords

cardiopulmonary bypass coronary artery bypass grafts off-pump surgery coronary artery disease

Get full access to this article

View all access options for this article.

References

Masuda

Kuwano

Okumura

et al . Thoracic and cardiovascular surgery in Japan during 2012: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 2014; 62: 734–764.

Lazar

HL.

Should off-pump coronary artery bypass grafting be abandoned?

Circulation 2013; 128: 406–413.

Racz

Hannan

Isom

et al . A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy. J Am Coll Cardiol 2004; 43: 557–564.

Hannan

Smith

et al . Off-pump versus on-pump coronary artery bypass graft surgery: differences in short-term outcomes and in long-term mortality and need for subsequent revascularization. Circulation 2007; 116: 1145–1152.

Sabik

Blackstone

Lytle

et al . Equivalent midterm outcomes after off-pump and on-pump coronary surgery. J Thorac Cardiovasc Surg 2004; 127: 142–148.

Filardo

Grayburn

Hamilton

et al . Comparing long-term survival between patients undergoing off-pump and on-pump coronary artery bypass graft operations. Ann Thorac Surg 2011; 92: 571–577; discussion 577–578.

Camacho

Culliford

et al . A comparison of long-term mortality for off-pump and on-pump coronary artery bypass graft surgery. Circ Cardiovasc Qual Outcomes 2012; 5: 76–84.

Mack

Pfister

Bachand

et al . Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. J Thorac Cardiovasc Surg 2004; 127: 167–173.

Khan

Islam

Ahmed

et al . On pump coronary artery bypass graft surgery versus off pump coronary artery bypass graft surgery: a review. Glob J Health Sci 2014; 6: 186–193.

10.

Ferraz

Escobar

et al . Off-pump versus on-pump coronary artery bypass surgery: meta-analysis and meta-regression of 13,524 patients from randomized trials. Rev Bras Cir Cardiovasc 2012; 27: 631–641.

11.

Urso

Sadaba

Pettinari

Impact of off-pump to on-pump conversion rate on post-operative results in patients undergoing off-pump coronary artery bypass. Interact Cardiovasc Thorac Surg 2012; 14: 188–193.

12.

Mukherjee

Rao

Ibrahim

et al . Meta-analysis of organ damage after conversion from off-pump coronary artery bypass procedures. Ann Thorac Surg 2011; 92: 755–761.

13.

Chowdhury

White

Kilgo

et al . Risk factors for conversion to cardiopulmonary bypass during off-pump coronary artery bypass surgery. Ann Thorac Surg 2012; 93: 1936–1941; discussion 1942.

14.

Bakaeen

Kelly

Chu

et al . Trends over time in the relative use and associated mortality of on-pump and off-pump coronary artery bypass grafting in the Veterans Affairs system. JAMA Surg 2013; 148: 1031–1036.

15.

Shroyer

Grover

Hattler

et al . On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med 2009; 361: 1827–1837.

16.

Muneretto

Bisleri

Negri

et al . Off-pump coronary artery bypass surgery technique for total arterial myocardial revascularization: a prospective randomized study. Ann Thorac Surg 2003; 76: 778–782; discussion 783.

17.

Straka

Widimsky

Jirasek

et al . Off-pump versus on-pump coronary surgery: final results from a prospective randomized study PRAGUE-4. Ann Thorac Surg 2004; 77: 789–793.

18.

Lingaas

Hol

Lundblad

et al . Clinical and radiologic outcome of off-pump coronary surgery at 12 months follow-up: a prospective randomized trial. Ann Thorac Surg 2006; 81: 2089–2095.

19.

Legare

Buth

King

et al . Coronary bypass surgery performed off pump does not result in lower in-hospital morbidity than coronary artery bypass grafting performed on pump. Circulation 2004; 109: 887–892.

20.

Khan

De Souza

Mister

et al . A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med 2004; 350: 21–28.

21.

Moller

Perko

Lund

et al . No major differences in 30-day outcomes in high-risk patients randomized to off-pump versus on-pump coronary bypass surgery: the best bypass surgery trial. Circulation 2010; 121: 498–504.

22.

Nathoe

van Dijk

Jansen

et al . A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients. N Engl J Med 2003; 348: 394–402.

23.

Masoumi

Saidi

Rostami

et al . Off-pump coronary artery bypass grafting in left ventricular dysfunction. Asian Cardiovasc Thorac Ann 2008; 16: 16–20.

24.

Mei

Wang

et al . On-pump versus off-pump coronary artery bypass surgery in high-risk patients. Int Heart J 2014; 55: 484–488.

25.

Raja

Benedetto

Off-pump coronary artery bypass grafting: misperceptions and misconceptions. World J Methodol 2014; 4: 6–10.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.03 MB