Joon Bum Kim1, Sung-Cheol Yun2, Jae Wong Lim1, Soo Kyung Hwang1, Sung-Ho Jung1, Hyun Song3, Cheol Hyun Chung1, Jae Won Lee1, Suk Jung Choo4. 1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 2. Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, South Korea. 3. Department of Thoracic and Cardiovascular Surgery, Seoul Saint Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea. 4. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: sjchoo@amc.seoul.kr.
Abstract
OBJECTIVES: This study sought to compare long-term survival after off- and on-pump coronary artery bypass grafting (CABG). BACKGROUND: Although several large-scale clinical trials have compared the surgical outcomes between off- and on-pump CABG, the long-term survival has not been compared between the 2 surgical strategies in a reasonably sized cohort. METHODS: We evaluated long-term survival data in 5,203 patients (age 62.9 ± 9.1 years, 1,340 females) who underwent elective isolated CABG (off-pump: n = 2,333; on-pump: n = 2,870) from 1989 through 2012. Vital statuses were validated using the Korean National Registry of Vital Statistics. Long-term survival was compared with the use of propensity scores and inverse probability weighting to adjust selection bias. RESULTS: Patients undergoing on-pump CABG had a higher number of distal anastomoses than those undergoing off-pump CABG (3.7 ± 1.2 vs. 3.0 ± 1.1; p < 0.001). Survival data were complete in 5,167 patients (99.3%), with a median follow-up duration of 6.4 years (interquartile range: 3.7 to 10.5 years; maximum 23.1 years). During follow-up, 1,181 patients (22.7%) died. After adjustment, both groups of patients showed a similar risk of death at 30 days (odds ratio: 0.70; 95% confidence interval [CI]: 0.35 to 1.40; p = 0.31) and up to 1 year (hazard ratio [HR]: 1.11; 95% CI: 0.74 to 1.65; p = 0.62). For overall mortality, however, patients undergoing off-pump CABG were at a significantly higher risk of death (HR: 1.43; 95% CI: 1.19 to 1.71; p < 0.0001) compared with those undergoing on-pump CABG. In subgroup analyses, on-pump CABG conferred survival benefits in most demographic, clinical, and anatomic subgroups compared with off-pump CABG. CONCLUSIONS: In patients undergoing elective isolated CABG, on-pump strategy conferred a long-term survival advantage compared with off-pump strategy.
OBJECTIVES: This study sought to compare long-term survival after off- and on-pump coronary artery bypass grafting (CABG). BACKGROUND: Although several large-scale clinical trials have compared the surgical outcomes between off- and on-pump CABG, the long-term survival has not been compared between the 2 surgical strategies in a reasonably sized cohort. METHODS: We evaluated long-term survival data in 5,203 patients (age 62.9 ± 9.1 years, 1,340 females) who underwent elective isolated CABG (off-pump: n = 2,333; on-pump: n = 2,870) from 1989 through 2012. Vital statuses were validated using the Korean National Registry of Vital Statistics. Long-term survival was compared with the use of propensity scores and inverse probability weighting to adjust selection bias. RESULTS:Patients undergoing on-pump CABG had a higher number of distal anastomoses than those undergoing off-pump CABG (3.7 ± 1.2 vs. 3.0 ± 1.1; p < 0.001). Survival data were complete in 5,167 patients (99.3%), with a median follow-up duration of 6.4 years (interquartile range: 3.7 to 10.5 years; maximum 23.1 years). During follow-up, 1,181 patients (22.7%) died. After adjustment, both groups of patients showed a similar risk of death at 30 days (odds ratio: 0.70; 95% confidence interval [CI]: 0.35 to 1.40; p = 0.31) and up to 1 year (hazard ratio [HR]: 1.11; 95% CI: 0.74 to 1.65; p = 0.62). For overall mortality, however, patients undergoing off-pump CABG were at a significantly higher risk of death (HR: 1.43; 95% CI: 1.19 to 1.71; p < 0.0001) compared with those undergoing on-pump CABG. In subgroup analyses, on-pump CABG conferred survival benefits in most demographic, clinical, and anatomic subgroups compared with off-pump CABG. CONCLUSIONS: In patients undergoing elective isolated CABG, on-pump strategy conferred a long-term survival advantage compared with off-pump strategy.
Authors: Ashima Singh; Hartzell V Schaff; Maria Mori Brooks; Mark A Hlatky; Stephen R Wisniewski; Robert L Frye; Edward Y Sako Journal: Eur J Cardiothorac Surg Date: 2015-05-11 Impact factor: 4.191
Authors: Krzysztof Laudanski; Natalia Lapko; Mateusz Zawadka; Benjamin X Zhou; Gwenn Danet-Desnoyers; George S Worthen Journal: PLoS One Date: 2017-07-17 Impact factor: 3.240
Authors: Ho Jin Kim; You Na Oh; Min Ho Ju; Joon Bum Kim; Sung-Ho Jung; Cheol Hyun Chung; Jae Won Lee; Suk Jung Choo Journal: J Thorac Dis Date: 2018-05 Impact factor: 2.895