Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: A prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting

Puskas, John D.; Williams, Willis H.; Duke, Peggy G.; Staples, James R.; Glas, Katherine E.; Marshall, J. Jeffrey; Leimbach, Mark E.; Huber, P; Garas, Samer M; Sammons, Bonnie H; McCall, Susan A.; Petersen, Rebecca J.; Bailey, Dianne E.; Chu, Haitao; Mahoney, Elizabeth M.; Weintraub, William S.; Guyton, Robert A.

doi:10.1067/mtc.2003.324

Cited by 532 publications

(419 citation statements)

References 23 publications

(31 reference statements)

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“…A standardized OPCAB approach in high-risk patients does not come at a price of less complete revascularization. This is an important aspect that has been highlighted to be a crucial predictor for the long-term outcome [7,8], but has also been reported to be a major argument against OPCAB [11,24,25]. Our findings are supported by Puskas et al [8] who demonstrated feasibility of complete revascularization using OPCAB.…”

Section: Discussionsupporting

confidence: 82%

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Off-pump surgery for the poor ventricle?

et al. 2011

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Severely decreased ejection-fraction is an established risk-factor for worse outcome after cardiac surgery. We compare outcomes of off-pump coronary artery bypass grafting (OPCAB) and on-pump CABG (ONCABG) in patients with severely compromised EF. From 2004 to 2009, 478 patients with a decreased EF B35% underwent myocardial-revascularization. Patients received either OPCAB (n = 256) or ONCABG (n = 222). Propensity score (PS), including 50 preoperative risk-factors, was used to balance characteristics between groups. PS adjusted logistic regression analysis was performed to assess mortality and major adverse cardiac and cerebrovascular events (MACCE). A composite endpoint for major non-cardiac complications such as respiratory failure, renal failure, rethoracotomy was applied. Complete revascularization (CR) was assumed when the number of distal anastomoses was larger than that of diseased vessels. There was no difference for mortality (2.3 vs. 4.1%; PS-adjusted odds ratio (PS-OR) = 1.05; p = 0.93) and MACCE (13.7 vs. 17.6%; PS-OR = 1.22; p = 0.50) including myocardial-infarction (1.4 vs. 4.9%; PS-OR = 0.39; p = 0.26), low cardiac output (2.3 vs. 4.7%; PS-OR = 0.75; p = 0.72) and stroke (2.3 vs.2.7%; PS-OR = 0.69; p = 0.66). OPCAB patients presented with a trend to less frequent occurrence of the non-cardiac composite (12.1 vs. 22.1%; PS-OR = 0.54; p = 0.059) including renal dysfunction (PAOR = 0.77; 95% CI 0.31-1.9; p = 0.57), bleeding (PAOR = 0.42; 95% CI 0.14-1.20; p = 0.10) and respiratory failure (PAOR = 0.39; 95% CI 0.05-3.29; p = 0.39). The rate of complete revascularization was similar (92.2 vs. 92.8%; PS-OR = 0.75; p = 0.50). OPCAB in patients with severely decreased EF is safe and feasible. It may even benefit these patients in regard to non-cardiac complications and does not come at cost of less complete revascularization.

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Section: Discussionsupporting

confidence: 82%

“…Off-pump coronary artery bypass surgery (OPCAB) has a comparable risk-adjusted mortality and morbidity as on-pump CABG [6][7][8]. Current reports suggest OPCAB to be superior for high-risk patients [9].…”

Section: Introductionmentioning

confidence: 99%

Off-pump surgery for the poor ventricle?

et al. 2011

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“…16,17 The most recent trial demonstrated decreased blood-product requirement, myocardial enzyme release, and length of hospitalization in beating-heart surgery patients. 18 Of the 3 published trials, 2 are single-surgeon experiences, and as such, the potential for bias in end points that are discretionary treatments (decision to extubate, discharge, and transfuse) is an important consideration. Moreover, the majority of these trials excluded high-risk patients, which brings into question the generalizability of the results.…”

Section: See P 810mentioning

confidence: 99%

Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump

et al. 2004

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Background-There is increasing evidence that cardiopulmonary bypass (CPB) may be responsible for the morbidity associated with coronary artery bypass grafting (CABG) surgery. Recent developments in cardiac stabilization devices have made CABG without CPB feasible. However, there is conflicting evidence to date from published trials comparing outcomes between CABG performed with and without CPB, with some trials indicating an advantage to the avoidance of CPB and others showing little benefit. Methods and Results-In a single-center randomized trial, 300 patients requiring CABG surgery at a single institution were prospectively randomized to have the procedure performed with CPB (nϭ150) or on the beating heart (nϭ150). Exclusion criteria for the trial included emergency procedure, concomitant major cardiac procedures, ejection fraction Ͻ30%, and reoperation. In-hospital outcomes were analyzed on an intention-to-treat basis. A mean of 3.0Ϯ0.9 grafts were performed in the CPB group compared with 2.8Ϯ0.9 grafts in the beating-heart group (Pϭ0.06). There were no significant differences between the CPB group and the beating-heart group in mortality (0.7% versus 1.3%; Pϭ1.0), transfusion (8.7% versus 9.3%), perioperative myocardial infarction (0.7% versus 2.7%; Pϭ0.37), permanent stroke (0% versus 1.3%; Pϭ0.50), new atrial fibrillation (32% versus 25%; Pϭ0.20), and deep sternal wound infection (0.7% versus 0%; Pϭ1.0). The mean time to extubation was 4 hours, the mean stay in the intensive care unit was 22 hours, and the median length of hospitalization was 5 days in both groups (PϭNS). Conclusions-In

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“…Additionally, the duration of the ICU stay for patients submitted to the surgery without ECC was significantly shorter than for patients that underwent the surgery with ECC, similarly to that observed by another study 11 . Other results, concerning the cost analysis, did not show a decrease in the ICU stay for patients without ECC; however, all of them showed a shorter intubation time [16][17][18] .…”

Section: Discussionmentioning

confidence: 95%

“…Several studies did not use stabilizers in all patients and, in many of them the equipment is re-usable [8][9][10][11][12][13][14][15][16][17][18] . The criteria for these procedures have not been discussed in depth; however, to ensure our patients' safety, especially those in whom the procedure involved the revascularization of latero-posterior wall of the left ventricle, the use of stabilizer was considered mandatory for all the patients in this group.…”

Section: Discussionmentioning

confidence: 99%