OBJECTIVE: To evaluate survival and readmissions to hospital for cardiac events or coronary revascularization (REVASC) in patients having off-pump (OPCAB) versus conventional on-pump (CCAB) coronary artery bypass graft surgery (CABG). METHODS: Of 11,368 consecutive patients undergoing isolated CABG between 1996 and 2002, 514 had OPCAB surgery. Using propensity scores, 503 CCAB patients were randomly matched to 503 OPCAB patients. RESULTS: There were no clinical or statistical differences between the two groups for any prognostic variable. However, OPCAB patients received significantly fewer distal anastomoses than the CCAB group (2.6+/-1.0 versus 3.1+/-1.0; P<0.001). There was no difference in operative mortality (OPCAB 1.0%, CCAB 1.4%; P=0.6), but the OPCAB group had significantly fewer operative strokes (0.2% versus 1.8%; P=0.01). Follow-up was 99.7% complete at 2.2+/-1.2 years (range 0 to 6 years). Twice as many OPCAB patients (n=24) required REVASC compared with the CCAB (n=11) group. The following five-year actuarial outcomes are presented for CCAB and OPCAB, respectively: survival: 77+/-6%, 76+/-8%, P=0.8; freedom from REVASC: 95+/-3%, 92+/-2%, P=0.02; and cardiac event-free survival: 76+/-5%, 62+/-8%; P=0.05. Cox regression revealed that OPCAB was a significant independent predictor of poorer freedom from REVASC (RR 2.2, 95% CI 1.0 to 4.6; P=0.04) and cardiac event-free survival (RR 1.6, 95%CI 1.1 to 2.2; P=0.02). CONCLUSIONS: The use of OPCAB remains controversial. These results, from this early experience, suggest that despite improved hospital outcomes, the lesser degree of REVASC raises concerns about the need for repeat revascularization in the OPCAB group.
OBJECTIVE: To evaluate survival and readmissions to hospital for cardiac events or coronary revascularization (REVASC) in patients having off-pump (OPCAB) versus conventional on-pump (CCAB) coronary artery bypass graft surgery (CABG). METHODS: Of 11,368 consecutive patients undergoing isolated CABG between 1996 and 2002, 514 had OPCAB surgery. Using propensity scores, 503 CCABpatients were randomly matched to 503 OPCAB patients. RESULTS: There were no clinical or statistical differences between the two groups for any prognostic variable. However, OPCAB patients received significantly fewer distal anastomoses than the CCAB group (2.6+/-1.0 versus 3.1+/-1.0; P<0.001). There was no difference in operative mortality (OPCAB 1.0%, CCAB 1.4%; P=0.6), but the OPCAB group had significantly fewer operative strokes (0.2% versus 1.8%; P=0.01). Follow-up was 99.7% complete at 2.2+/-1.2 years (range 0 to 6 years). Twice as many OPCAB patients (n=24) required REVASC compared with the CCAB (n=11) group. The following five-year actuarial outcomes are presented for CCAB and OPCAB, respectively: survival: 77+/-6%, 76+/-8%, P=0.8; freedom from REVASC: 95+/-3%, 92+/-2%, P=0.02; and cardiac event-free survival: 76+/-5%, 62+/-8%; P=0.05. Cox regression revealed that OPCAB was a significant independent predictor of poorer freedom from REVASC (RR 2.2, 95% CI 1.0 to 4.6; P=0.04) and cardiac event-free survival (RR 1.6, 95%CI 1.1 to 2.2; P=0.02). CONCLUSIONS: The use of OPCAB remains controversial. These results, from this early experience, suggest that despite improved hospital outcomes, the lesser degree of REVASC raises concerns about the need for repeat revascularization in the OPCAB group.
Authors: M E Plomondon; J C Cleveland; S T Ludwig; G K Grunwald; C I Kiefe; F L Grover; A L Shroyer Journal: Ann Thorac Surg Date: 2001-07 Impact factor: 4.330
Authors: F Hernandez; W E Cohn; Y R Baribeau; J F Tryzelaar; D C Charlesworth; R A Clough; J D Klemperer; J R Morton; B M Westbrook; E M Olmstead; G T O'Connor Journal: Ann Thorac Surg Date: 2001-11 Impact factor: 4.330
Authors: D van Dijk; A P Nierich; E W Jansen; H M Nathoe; W J Suyker; J C Diephuis; W J van Boven; C Borst; E Buskens; D E Grobbee; E O Robles De Medina; P P de Jaegere Journal: Circulation Date: 2001-10-09 Impact factor: 29.690
Authors: Muhammad Shahzeb Khan; Mohammad Yousuf-Ul Islam; Muhammad Umer Ahmed; Faizan Imran Bawany; Asadullah Khan; Mohammad Hussham Arshad Journal: Glob J Health Sci Date: 2014-03-24
Authors: Carlo Bassano; Paolo Nardi; Dario Buioni; Laura Asta; Calogera Pisano; Fabio Bertoldo; Claudia Altieri; Giovanni Ruvolo Journal: Int J Environ Res Public Health Date: 2021-12-27 Impact factor: 3.390