Impact of pump status and conduit choice in coronary artery bypass: A 15-year follow-up study in 1412 propensity-matched patients

Grau, Juan B.; Johnson, Christopher K.; Kuschner, Cyrus E.; Ferrari, Giovanni; Shaw, Richard E.; Brizzio, Mariano E.; Zapolanski, Alex

doi:10.1016/j.jtcvs.2014.12.031

Cited by 25 publications

(10 citation statements)

References 26 publications

(36 reference statements)

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“…27, 32 In the longterm, a recent study demonstrated that the 15-year survival between on-and off-pump groups was not different (72.8% and 76.5% for bilateral ITA and 61.8% and 67.2% for single ITA, respectively), and the pump status did not influence longterm survival. 33 They also reported that bilateral ITA grafting and complete revascularization were independent factors improving overall survival. In the present study, the mean number of distal anastomoses was 3.4±1.0 in the entire cohort,…”

Section: Discussionmentioning

confidence: 97%

Does Age at Operation Influence the Short- and Long-Term Outcomes of Off-Pump Coronary Artery Bypass Grafting?

Ohira

Doi

Numata

et al. 2015

Circ J

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Section: Discussionmentioning

confidence: 97%

Does Age at Operation Influence the Short- and Long-Term Outcomes of Off-Pump Coronary Artery Bypass Grafting?

Ohira

Doi

Numata

et al. 2015

Circ J

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“…Therefore, surgeons should perform off-pump surgery only if they are confident of performing the same extent of revascularization as they would by using CPB. This fact is validated by a 15-year follow-up study of 1,412 propensity matched patients, which demonstrated no difference in survival at a mean follow-up of approximately 10 years between patients undergoing on-or off-pump bilateral ITA-saphenous vein grafting and also between on-or off-pump single ITA-saphenous vein graft CABG cases, but revealed a significant survival benefit in favor of patients undergoing bilateral ITA-saphenous vein graft as compared to single ITA-saphenous vein graft CABG (91). This study proved that the use of CPB does not significantly affect the long-term outcomes in patients as long as full revascularization with similar conduits is achieved.…”

Section: Efficacymentioning

confidence: 97%

Current outcomes of off-pump coronary artery bypass grafting: evidence from real world practice

Davierwala

2016

J. Thorac. Dis.

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Coronary artery bypass grafting (CABG) can be performed conventionally using cardiopulmonary bypass (CPB) and aortic clamping or on a beating heart (BH) without the use of CPB, the so-called off-pump CABG. Some surgeons, who are proponents of off-pump CABG, preferentially use this technique for the majority of operations, whereas others use it only in certain situations which warrant avoidance of CPB. Ever since the conception of off-pump CABG, the never-ending debate about which technique of CABG is safe and efficacious continues to date. Several randomized controlled trials (RCTs) have been conducted that have either favored on-pump CABG or have failed to show a significant difference in outcomes between the two techniques. However, these RCTs have been fraught with claims that they do not represent the majority of patients undergoing CABG in real world practice. Therefore, assessment of the benefits and drawbacks of each technique through observational and registry studies would be more representative of patients encountered in daily practice. The present review examines various retrospective studies and meta-analyses of observational studies that compare the early and long-term outcomes of off- and on-pump CABG, which assesses their safety and efficacy. Additionally, their outcomes in older patients, females, and those with diabetes mellitus, renal dysfunction, presence of ascending aortic disease, and/or acute coronary syndrome (ACS) have also been discussed separately. The general consensus is that early results of off-pump CABG are comparable to or in some cases better than on-pump CABG. However, on-pump CABG provides a survival benefit in the long term according to a majority of publications in literature.

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“…A total of 38 observational studies were selected for the quantitative analysis. Eight nonadjusted, 9 covariate‐adjusted, and 21 PSM studies were included (see Table ) . Twenty‐eight studies (162 989 patients) were performed in the general population, whereas 10 (11 216 patients) were performed in specific subgroups of patients (diabetics: 3 studies [1533 patients]; elderly: 4 studies [6033 patients]; renal failure patients: 1 study [1203 patients]; urgent/emergent cases: 1 study [652 patients]; and patients with low ejection fraction: 1 study [1795 patients]).…”

Section: Resultsmentioning

confidence: 99%

“…Twenty‐eight studies (162 989 patients) were performed in the general population, whereas 10 (11 216 patients) were performed in specific subgroups of patients (diabetics: 3 studies [1533 patients]; elderly: 4 studies [6033 patients]; renal failure patients: 1 study [1203 patients]; urgent/emergent cases: 1 study [652 patients]; and patients with low ejection fraction: 1 study [1795 patients]). An overview of the studies is summarized in Tables and (variables included for PSM are summarized in Table ).…”

Section: Resultsmentioning

confidence: 99%

Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta‐Analysis

Gaudino

Franco

Rahouma

et al. 2018

JAHA

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BackgroundObservational studies suggest a survival advantage with bilateral single internal thoracic artery (BITA) versus single internal thoracic artery grafting for coronary surgery, whereas this conclusion is not supported by randomized trials. We hypothesized that this inconsistency is attributed to unmeasured confounders intrinsic to observational studies. To test our hypothesis, we performed a meta‐analysis of the observational literature comparing BITA and single internal thoracic artery, deriving incident rate ratio for mortality at end of follow‐up and at 1 year. We postulated that BITA would not affect 1‐year survival based on the natural history of coronary artery bypass occlusion, so that a difference between groups at 1 year could not be attributed to the intervention.Methods and ResultsWe searched MEDLINE and Pubmed to identify all observational studies comparing the outcome of BITA versus single internal thoracic artery. One‐year and long‐term mortality for BITA and single internal thoracic artery were compared in the propensity‐score–matched (PSM) series, that is, the form of observational evidence less prone to confounders. Thirty‐eight observational studies (174 205 total patients) were selected for final comparison. In the 12 propensity‐score–matched series (34 019 patients), the mortality reduction for BITA was similar at 1 year and at the end of follow‐up (incident rate ratio, 0.70; 95% confidence interval, 0.60–0.82 versus 0.77; 95% confidence interval, 0.70–0.85; P for subgroup difference=0.43).ConclusionsUnmeasured confounders, rather than biological superiority, may explain the survival advantage of BITA in observational series.

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Impact of pump status and conduit choice in coronary artery bypass: A 15-year follow-up study in 1412 propensity-matched patients

Cited by 25 publications

References 26 publications

Does Age at Operation Influence the Short- and Long-Term Outcomes of Off-Pump Coronary Artery Bypass Grafting?

Does Age at Operation Influence the Short- and Long-Term Outcomes of Off-Pump Coronary Artery Bypass Grafting?

Current outcomes of off-pump coronary artery bypass grafting: evidence from real world practice

Unmeasured Confounders in Observational Studies Comparing Bilateral Versus Single Internal Thoracic Artery for Coronary Artery Bypass Grafting: A Meta‐Analysis

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