On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in a Matched Sample of Women

Abstract

Background-Women have consistently higher mortality and morbidity than men after coronary artery bypass grafting (CABG). Whether elimination of cardiopulmonary bypass and performance of coronary artery bypass grafting off-pump (OPCAB) have a beneficial effect specifically in women has not been defined. Methods and Results-From January 1998 through March 2002, 21 902 consecutive female patients at 82 hospitals underwent isolated CABG, as reported in an administrative database. Propensity score computer matching was performed based on 13 variables representing patient characteristics and preoperative risk factors to correct for and minimize selection bias. A total of 7376 (3688 pairs) women undergoing CABG surgery were able to be successfully matched. In a propensity score computer-matched cohort, multivariate logistic regression (odds ratio) revealed that women undergoing on-pump surgery had a 73.3% higher mortality (Pϭ0.002) and a 47.2% higher risk of bleeding complications (Pϭ0.019). Conclusions-In a retrospective analysis of women undergoing CABG, computer-matched to minimize selection bias, off-pump surgery led to decreased mortality and morbidity including bleeding complications.

Cirurgia de revascularização miocárdica com circulação extracorpórea versus sem circulação extracorpórea: uma metanálise

“…The inclusion criteria were applied to the 94 studies assessed, but only nine articles were selected and evaluated in details. These were all published studies, of which clinical characteristics are shown in Table 1 [42][43][44][45][46][47][48][49][50] .…”

“…Mortality was reported in seven studies (23,163 patients, Figure 1) 42,[44][45][46][47][48]50 and according to the analysis, it was significantly lower in off-pump group (OR = 0.82, 95%CI: 0.70 -0.98, p = 0.03), with heterogeneity regarding the overall effect in the sample (Chi 2 = 24.51, p = 0.0004). The OR represents a 18% reduction in the mortality risk in favor of the OPCABG surgical technique and must be considered with care in the context of the heterogeneity among the studies mentioned above.…”

“…Kidney complications were reported in five studies (59,410 patients, Figure 3) [43][44][45]47,50 and the analysis showed there was heterogeneity regarding the overall effect in the sample (Chi 2 = 10.01, p = 0.04). The meta-analysis showed no significant difference in kidney complications, indicating an OR of 0.97 (95%CI: 0.84 -1.14, p = 0.74).…”

Gender‐based issues in interventional cardiology: A consensus statement from the Women in Innovations (WIN) Initiative

“…A study of 16,871 consecutive women comparing off‐pump and on‐pump CABG surgery demonstrated that those who underwent off‐pump surgery had a better clinical outcome with reduced mortality, respiratory complications, and length of hospital stay [28]. Similarly, a more recent study investigated 7,376 women undergoing CABG surgery [29]. Compared to a propensity‐matched sample of females who underwent off‐pump CABG surgery, women who underwent conventional CABG surgery had a 73% higher mortality rate, and a 47% higher complication rate due to bleeding.…”

Thrombin and cardiopulmonary bypass – A paradigm for evaluation of the regulation of hemostasis

“…In an effort to minimize the CPB-induced abnormalities associated with coronary artery bypass grafting, especially those due to biocompatibility of bypass circuits, surgeons have eliminated the bypass circuit by using direct coronary artery revascularization on the beating heart (OPCAB). Comparisons of postoperative bleeding in on-pump procedures versus OPCAB have usually [125,155,162,187], but not always [76,92], shown reduced levels of bleeding after OPCAB. Interestingly, Lo and co-workers found that the despite heparinization, CABG surgery with CPB (ONCAB) was associated with excessive thrombin generation and fibrinolytic activity immediately after surgery, but OPCAB group demonstrated a delayed postoperative response that became equal in magnitude to the ONCAB in the later (20-96 h) postoperative period [123].…”