Impact of Surgeon Experience and Centre Volume on Outcome After Off-Pump Coronary Artery Bypass Surgery: Results From the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) Registry

Naito, Shokichi; Demal, T. J.; Sill, B.; Reichenspurner, Hermann; Gatti, Giuseppe; Mariscalco, Giovanni; Faggian, Giuseppe; Salsano, Antonio; Santini, Francesco; Santarpino, Giuseppe; Zanobini, Marco; Musumeci, Francesco; Rubino, A; Bancone, Ciro; Feo, Marisa De; Nicolini, Francesco; Dalén, Magnus; Saglio, Giuseppe; Bounader, Karl; Mäkikallio, Timo H.; Tauriainen, Tuomas; Ruggieri, Vito Giovanni; Perrotti, Andréa; Biancari, Fausto

doi:10.1016/j.hlc.2022.11.009

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…Recently, the significance of surgeon experience and center volume has gained much interest, including the number of surgical revascularization procedures performed on a beating heart, which is center-dependent [ 17 ]. The latter conclusion is in co-ordinance with a previous report presented by Benedetto et al [ 18 ] and may explain the difference with our analysis.…”

Section: Discussionmentioning

confidence: 99%

Left main coronary artery disease treated with beating heart surgery: 10-year single center results

Urbanowicz,

Michalak,

Olasińska-Wiśniewska

et al. 2024

pwki

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Introduction Left main (LM) coronary disease is believed to represent a complex, advanced, and potentially life-threatening atherosclerotic syndrome that can be treated by either percutaneous or surgical interventions. Despite its satisfactory results, the declined number of off-pump coronary artery bypass grafting (OPCAB) is observed. Aim To compare 10-year survival and point out possible mortality risk factors in patients referred for left main and multivessel OPCAB surgery followed by transit time bypass measurements. Material and methods There were 159 patients (128 (81%) men and 31 (19%) women) in a median age of 66 (60–70) years enrolled in retrospective analysis who were referred to surgical intervention due to left main (51, 32%) and multivessel (108, 68%) disease. The regression analysis for long-term mortality risk and the Kaplan-Meyer survival curve were analyzed. Results Multivariable analysis pointed female sex (HR = 1.08, 95% CI: 1.03–1.14, p = 0.001) and diabetes mellitus (HR = 6.33, 95% CI: 1.86–21.52, p = 0.003) as possible risk factors for 10-year mortality risk. There was no significant difference in Kaplan-Meyer 10-year mortality comparison between left main and multivessel disease patients treated by off-pump surgical revascularization (HR = 0.93, 95% CI: 0.40–2.13, p = 0.86). Conclusions Off-pump surgery in the left main disease, compared to multivessel disease, represents a safe surgical technique with satisfactory long-term results. The female sex and diabetes mellitus were found as possible risk factors for 10-year mortality risk in multivariable analysis.

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Section: Discussionmentioning

confidence: 99%

Left main coronary artery disease treated with beating heart surgery: 10-year single center results

Urbanowicz,

Michalak,

Olasińska-Wiśniewska

et al. 2024

pwki

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“…OPCAB also seems to be of benefit in several high-risk groups. Naito et al showed that, in experience OPCAB centres, there was a lower post-procedural acute kidney injury, shorter duration of intensive care unit stay and lower 30-day mortality [ 17 ]. In patients with high surgical risk, meta-analyses have observed reduced perioperative morbidity and mortality [ 18 ], especially for those in the highest-risk quartiles [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous coronary interventions are now being routinely offered to patients with multivessel and/or left main coronary artery disease. Therefore, future patients requiring CABG will more likely have complex coronary artery disease [ 17 , 22 ]. Furthermore, it is expected that the incidence of high-risk profile patients with atherosclerotic aorta, reduced left ventricular ejection fraction, stroke and/or renal failure will continue to rise.…”

Section: Discussionmentioning

confidence: 99%

Trend and early clinical outcomes of off-pump coronary artery bypass grafting in the UK

Chan

Dimagli

Dong

et al. 2023

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES The popularity of off pump coronary artery bypass grafting varies across the world, ranging from 20% in Europe and USA to 56% in Asia. We present the trend and early clinical outcomes in off pump in the United Kingdom. METHOD All patients who underwent elective or urgent isolated CABG from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. The trend in operating surgeons and units volume and training in off pump were analysed. Early clinical outcomes between off- and on pump Coronary Artery Bypass grafting were compared using propensity score matching. RESULTS A total 351422 patients were included. The overall off pump rate during the study period was 15.17%, it peaked in 2008 (19.8%), followed by a steady decreased to 2018 (7.63%). Its adoption varied across centres and surgeons, ranging from <1% to 48.36% and <1% to 85.5% respectively of total cases performed. After propensity score matching for the period 1996–2019, off pump, when compared to on pump, was associated with a lower in-hospital/30 day mortality (1.2% vs 1.5%, p < 0.001), return to theatre (3.7% vs 4.5%, p < 0.001), cerebrovascular accident (Transient Ischaemic Attack: 0.3% vs 0.6%, Stroke: 0.3% vs 0.6%, p < 0.001) and deep sternal wound infection (0.8% vs 1.2%, p = <0.001). In a sub analysis from the introduction of Euroscore II (2012–2019) there was no differences in-hospital/30 day mortality [1.0% vs 1.0%, p = 0.71]. However, on pump, had a higher return to theatre [4.2% vs 2.7%, p < 0.001], cerebrovascular accident [Transient Ischaemic Attack: 0.4% vs 0.2%, Stroke: 0.5% vs 0.3%, p = 0.003] and deep sternal wound infection [1.0% vs 0.6%, p = 0.004]. CONCLUSION Our data show a decreasing trend in the use of off pump in the UK since 2008. This is likely to be multifactorial and raises the question on whether it should be a specialized revascularisation technique.

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“…32 Naito et al also demonstrate a volume-outcome relationship for off-pump CABG. 33 To benefit from CABG, patients need patent bypass grafts. Graft selection is one of the crucial factors for optimizing graft patency and patient outcomes.…”

Section: Technical Aspects Of Cabgmentioning

confidence: 99%

Cardiac Surgery 2023 Reviewed

Kirov,

Caldonazo,

Mukharyamov

et al. 2024

Thorac Cardiovasc Surg

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We reviewed the cardiac surgical literature for 2023. PubMed displayed almost 34,000 hits for the search term “cardiac surgery AND 2023.” We used a PRISMA approach for a results-oriented summary. Key manuscripts addressed the mid- and long-term effects of invasive treatment options in patient populations with coronary artery disease (CAD), comparing interventional therapy (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass graft [CABG]). The literature in 2023 again confirmed the excellent long-term outcomes of CABG compared with PCI in patients with left main stenosis, specifically in anatomically complex chronic CAD, but even in elderly patients, generating further support for an infarct-preventative effect as a prognostic mechanism of CABG. For aortic stenosis, a previous trend of an early advantage for transcatheter (transcatheter aortic valve implantation [TAVI]) and a later advantage for surgical (surgical aortic valve replacement) treatment was also re-confirmed by many studies. Only the Evolut Low Risk trial maintained an early advantage of TAVI over 4 years. In the mitral and tricuspid field, the number of interventional publications increased tremendously. A pattern emerges that clinical benefits are associated with repair quality, making residual regurgitation not irrelevant. While surgery is more invasive, it currently generates the highest repair rates and longest durability. For terminal heart failure treatment, donor pool expansion for transplantation and reducing adverse events in assist device therapy were issues in 2023. Finally, the aortic diameter related to adverse events and technical aspects of surgery dominated in aortic surgery. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for patient-specific decision-making.

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Impact of Surgeon Experience and Centre Volume on Outcome After Off-Pump Coronary Artery Bypass Surgery: Results From the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) Registry

Cited by 6 publications

References 20 publications

Left main coronary artery disease treated with beating heart surgery: 10-year single center results

Left main coronary artery disease treated with beating heart surgery: 10-year single center results

Trend and early clinical outcomes of off-pump coronary artery bypass grafting in the UK

Cardiac Surgery 2023 Reviewed

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