A Comparison of On-Pump and Off-Pump Coronary Bypass Surgery in Low-Risk Patients

Nathoe, Hendrik M.; Dijk, Diederik van; Jansen, Erik; Suyker, Willem J.L.; Diephuis, Jan C.; Boven, Wim-Jan van; Rivière, Aart Brutel de la; Borst, Cornelius; Kalkman, Cor J.; Grobbee, Diederick E.; Buskens, Erik; Jaegere, Peter P.T. de

doi:10.1056/nejmoa021775

Cited by 367 publications

(185 citation statements)

References 39 publications

(29 reference statements)

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“…The first resource that was examined showed no significant differences in ICULOS between the ONCAB and OPCAB groups in either male or female populations. This is in agreement with previous reports (13)(14)(15). Other studies (16)(17)(18) have reported significant differences in ICULOS between ONCAB and OPCAB groups; however, these have been mostly retrospective, unadjusted observational studies.…”

Section: Discussionsupporting

confidence: 93%

Sex differences in resource use after on-pump and off-pump coronary artery bypass surgery: A propensity score-matched cohort

Maganti

Rao

Cusimano

2009

Canadian Journal of Cardiology

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B eating heart revascularization gained popularity several years previously as an attractive method to reduce the morbidity and mortality associated with cardiopulmonary bypass surgery (CPB). As technological advances improved the ability of surgeons to reproduce the results of 'off-pump' coronary artery bypass surgery (OPCAB), several clinical trials were initiated to compare the early clinical outcomes of OPCAB with those of standard myocardial revascularization using a CPB circuit (on-pump coronary artery bypass surgery [ONCAB]).While the majority of observational studies favoured clinical outcomes following OPCAB, these results were not substantiated in subsequent randomized clinical trials. Indeed, a recent meta-analysis (1) suggested very little benefit of OPCAB over conventional ONCAB. Despite these findings, most surgeons continue to believe that OPCAB is beneficial in certain high-risk subgroups. The present study examined whether there are sex-specific benefits of OPCAB, particularly with respect to hospital resource use. To adjust for the selected nature of OPCAB patients, a propensity score analysis was performed to match male and female cohorts with standard preoperative demographic characteristics. The present study demonstrates that the potential beneficial effects of OPCAB are not observed in female patients. In contrast, there were significant benefits in resource use for male patients undergoing isolated myocardial revascularization using an off-pump technique. BACkgROunD: Previous studies have demonstrated that off-pump coronary artery bypass surgery (OPCAB) is associated with less use of hospital resources compared with on-pump coronary artery bypass surgery (ONCAB). OBJECTiVE: To determine whether there is a sex effect between the two procedures regarding resource utilization. METHODS: Between 1996 and 2004, 13,522 patients (10,637 men and 2885 women) underwent coronary artery bypass grafting surgery at the Toronto General Hospital (Toronto, Ontario). Among the men, 10,121 patients underwent ONCAB and 516 underwent OPCAB. The female population consisted of 2723 ONCAB and 162 OPCAB patients. Both groups were matched to standard preoperative risk factors. A propensity score macro-matched 471 OPCAB men to 471 ONCAB men, and 148 OPCAB women to 148 ONCAB women. RESuLTS: The mean (± SD) postoperative length of stay (7.5±6.5 days versus 6.4±5.5 days; P<0.0001) was significantly higher in ONCAB compared with OPCAB in the male population. The mean length of stay in the intensive care unit and the mean ventilation time was similar between the groups. However, in the female population, there were no differences in mean posoperative length of stay (8±5.9 days versus 8±6 days; P=0.4), mean length of stay in the intensive care unit (43±38 h versus 53±81 h; P=0.4) or mean ventilation time (9.8±9.7 h versus 11±13 h; P=0.8). COnCLuSiOn: These results suggest that the benefits of OPCAB in terms of hospital resource use are influenced by sex. The potential beneficial effects are not demonstrated in the female ...

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Section: Discussionsupporting

confidence: 93%

Sex differences in resource use after on-pump and off-pump coronary artery bypass surgery: A propensity score-matched cohort

Maganti

Rao

Cusimano

2009

Canadian Journal of Cardiology

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“…As surgeons have gained experience with off-pump surgery, this difference has been eliminated. In a study published in 2003, Nathoe et al (40) randomly assigned 265 low-risk patients to on-pump or off-pump surgery. After one year, there was no difference in graft patency (93% versus 91%, respectively) or composite end point of death, MI, stroke or myocardial revascularization.…”

Section: Surgical Techniquementioning

confidence: 99%

Coronary vein graft disease: Pathogenesis and prevention

Parang

Arora

2009

Canadian Journal of Cardiology

150

109

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“…5 New techniques including minimally invasive surgery which does not require the use of total bypass and has shortened surgical time, is currently being introduced and evaluated. 8, 9 The outcomes of CABG versus use of coronary artery stents was the topic of a previous review 2 and will not be dealt with further in this report.…”

Section: Cabgmentioning

confidence: 99%

Drug-eluting stents: a systematic review and economic evaluation

Hill¹,

Boland²,

Dickson³

et al. 2007

Health Technol Assess

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A Comparison of On-Pump and Off-Pump Coronary Bypass Surgery in Low-Risk Patients

Abstract: In low-risk patients, there was no difference in cardiac outcome at one year between those who underwent on-pump bypass surgery and those who underwent off-pump surgery. Off-pump surgery was more cost effective.

Cited by 367 publications

References 39 publications

Sex differences in resource use after on-pump and off-pump coronary artery bypass surgery: A propensity score-matched cohort

Sex differences in resource use after on-pump and off-pump coronary artery bypass surgery: A propensity score-matched cohort

Coronary vein graft disease: Pathogenesis and prevention

Drug-eluting stents: a systematic review and economic evaluation

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