Off-pump coronary bypass grafting is safe and efficient in patients with left main disease and higher EuroScore☆

Thomas, George N.; Martinez, Eliana C.; Woitek, Felix; Emmert, Maximilian Y.; Sakaguchi, Hisashi; Muecke, Sonja; Lee, Chuen Neng; Kofidis, Theo

doi:10.1016/j.ejcts.2009.04.029

Cited by 15 publications

(14 citation statements)

References 26 publications

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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: 81%

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: 81%

Off-pump surgery for the poor ventricle?

et al. 2011

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“…The consent process in cardiac surgery is a surgeon-patient accord that is based on complex assessments of risk-benefit, with objective systems, such as the logistic EuroSCORE, in common use [ 3,39]. To put our findings into perspective, a 1 in 100 quoted risk of operative mortality rises to a risk of approximately 1 in 14 (7%) if emergency conversion occurs and about 1 in 16 (6.2%), if any conversion occurs.…”

Section: Consent Issuesmentioning

confidence: 92%

Intra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis

Mukherjee

Ashrafian

Kourliouros

et al. 2012

European Journal of Cardio-Thoracic Surgery

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Coronary artery bypass surgery can offer excellent results when performed with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass (off pump). The debate as to which technique is superior remains unanswered. Intra-operative conversion from off- to on-pump coronary surgery is a relatively unexplored phenomenon, which cannot be assessed within randomised controlled trial design. We aimed to assess the effect of off-pump conversion on patient mortality. Medline, Embase, Cochrane and Google Scholar databases were systematically reviewed for studies published between 1980 and 2010 that compared the incidence of mortality between converted and non-converted off-pump patients. Publication bias and heterogeneity were assessed and data were extracted independently by multiple observers. We undertook a meta-analysis of these studies using random effects modelling. A total of 17 studies fulfilled our inclusion criteria, containing data for 18,870 off-pump coronary artery bypass operations spanning a decade (1998-2008), involving 920 cases of conversion. Overall, conversion increased mortality by an odds ratio of 6.18 (95% confidence interval 4.65-8.20), whereas emergency conversion further raised the odds ratio of mortality to 6.99 (95% confidence interval 5.18-9.45). The conversion from off- to on-pump cardiac surgery may significantly increase the chance of an adverse outcome, whereas emergency conversion confers a significant rise in mortality. The risk of conversion should be discussed when obtaining the patient's informed consent and its prevention warrants serious consideration by cardiac surgeons and cardiac surgical training programmes.

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“…Although numerous encouraging studies showed the safety of OPCABG in patients with LMD and calcified AA [1][2][3], this experience indicated that this may not always be the case. Patients with LMD are more prone to having calcified AA and aortic root.…”

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confidence: 75%

“…In the October 2009 issue of your journal, Thomas et al [1] report the safety of off-pump coronary artery bypass grafting (OPCABG) in patients with left main disease (LMD). However, although they address in their introduction the fact that patients with LMD are at higher risk of having calcified ascending aortas (AAs), they do not discuss this issue any further.…”

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confidence: 99%

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Kofidis

2011

European Journal of Cardio-Thoracic Surgery

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Cyril (2017) Physical and biological characteristics of multi drug resistance (MDR): an integral approach considering pH and drug resistance in Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/39780/1/Rauch%20-%20corrections%20accepted%20and %20not%20visible.pdf Copyright and reuse: The Nottingham ePrints service makes this work by researchers of the University of Nottingham available open access under the following conditions. This article is made available under the Creative Commons Attribution Non-commercial No Derivatives licence and may be reused according to the conditions of the licence. For more details see: http://creativecommons.org/licenses/by-nc-nd/2.5/ A note on versions: The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. For more information, please contact eprints@nottingham.ac.uk Physical and biological characteristics of multi drug resistance (MDR): An integral 1 approach considering pH and drug resistance in cancer. Abstract 20 The role of the Warburg effect in cancer remains to be elucidated with a resurgence in research 21 efforts over the past decade. Why a cancer cell would prefer to use energy inefficient 22

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Off-pump coronary bypass grafting is safe and efficient in patients with left main disease and higher EuroScore☆

Abstract: The presence of LMD and higher EuroSCORE does not yield adverse outcomes in OPCAB patients.

Cited by 15 publications

References 26 publications

Off-pump surgery for the poor ventricle?

Off-pump surgery for the poor ventricle?

Intra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis

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