Paula Carmona1, Federico Paredes2, Eva Mateo3, Armando V Mena-Durán4, Fernando Hornero4, Juan Martínez-León4. 1. Department of Cardiovascular-Anesthesia and Intensive Care, University Hospital La Fe, Valencia, Spain. 2. Department of Cardiac Surgery, General Hospital of Valencia, Valencia, Spain feco_py@hotmail.com. 3. Department of Cardiovascular-Anesthesia and Intensive Care, University General Hospital, Valencia, Spain. 4. Department of Cardiac Surgery, General Hospital of Valencia, Valencia, Spain.
Abstract
OBJECTIVES: We aim to describe our experience in coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass by comparing intraoperative and postoperative outcomes. METHODS: From January 1993 to June 2013, 3097 patients underwent consecutive emergency and scheduled CABG surgery. A total of 1770 patients underwent on-pump CABG (ONCABG) and 1327 off-pump CABG (OPCABG). A propensity score matching was performed to identify appropriate matched-pair patients; univariable and multivariable logistic regression analyses were performed to assess significant predictors of hospital and 30-day morbidity and mortality composite end-points. Morbidity composite end-point was defined as any renal, pulmonary, cardiovascular and neurological complication that occurred during hospital stay. We collected all-cause mortality data during the study period. RESULTS: We identified 1004 patients in each group. There were no significant differences in thirty day mortality, 2.8 vs 3.8%, in OPCABG and ONCABG, respectively (P = 0.21). Cardiovascular, neurological, respiratory and renal complications were more frequent in the ONCABG group: 13.9 vs 8.7% (P < 0.001), 3.9 vs 2.2% (P = 0.03), 13.5 vs 7.5% (P < 0.001), 7.1 vs 5.3% (P = 0.095), respectively. The long-term all-cause mortality rate was 12.3 vs 12.9% in the OPCABG versus ONCABG group (P = 0.42), respectively. In both uni- and multivariable analysis preoperative renal failure, chronic obstructive pulmonary disease and ONCABG were independent predictors of mortality and morbidity composite end-points. CONCLUSIONS: OPCABG is associated with less postoperative morbimortality and shorter hospital and intensive care unit length of stay. ONCABG resulted as an independent predictor of morbidity and mortality composite end-point. No statistically significant differences were observed in long-term all-cause mortality between groups.
OBJECTIVES: We aim to describe our experience in coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass by comparing intraoperative and postoperative outcomes. METHODS: From January 1993 to June 2013, 3097 patients underwent consecutive emergency and scheduled CABG surgery. A total of 1770 patients underwent on-pump CABG (ONCABG) and 1327 off-pump CABG (OPCABG). A propensity score matching was performed to identify appropriate matched-pair patients; univariable and multivariable logistic regression analyses were performed to assess significant predictors of hospital and 30-day morbidity and mortality composite end-points. Morbidity composite end-point was defined as any renal, pulmonary, cardiovascular and neurological complication that occurred during hospital stay. We collected all-cause mortality data during the study period. RESULTS: We identified 1004 patients in each group. There were no significant differences in thirty day mortality, 2.8 vs 3.8%, in OPCABG and ONCABG, respectively (P = 0.21). Cardiovascular, neurological, respiratory and renal complications were more frequent in the ONCABG group: 13.9 vs 8.7% (P < 0.001), 3.9 vs 2.2% (P = 0.03), 13.5 vs 7.5% (P < 0.001), 7.1 vs 5.3% (P = 0.095), respectively. The long-term all-cause mortality rate was 12.3 vs 12.9% in the OPCABG versus ONCABG group (P = 0.42), respectively. In both uni- and multivariable analysis preoperative renal failure, chronic obstructive pulmonary disease and ONCABG were independent predictors of mortality and morbidity composite end-points. CONCLUSIONS: OPCABG is associated with less postoperative morbimortality and shorter hospital and intensive care unit length of stay. ONCABG resulted as an independent predictor of morbidity and mortality composite end-point. No statistically significant differences were observed in long-term all-cause mortality between groups.
Authors: Brack Hattler; John C Messenger; A Laurie Shroyer; Joseph F Collins; Scott J Haugen; Joel A Garcia; Janet H Baltz; Joseph C Cleveland; Dimitri Novitzky; Frederick L Grover Journal: Circulation Date: 2012-05-16 Impact factor: 29.690
Authors: L H Edmunds; R E Clark; L H Cohn; G L Grunkemeier; D C Miller; R D Weisel Journal: J Thorac Cardiovasc Surg Date: 1996-09 Impact factor: 5.209
Authors: Philippe Kolh; Stephan Windecker; Fernando Alfonso; Jean-Philippe Collet; Jochen Cremer; Volkmar Falk; Gerasimos Filippatos; Christian Hamm; Stuart J Head; Peter Jüni; A Pieter Kappetein; Adnan Kastrati; Juhani Knuuti; Ulf Landmesser; Günther Laufer; Franz-Josef Neumann; Dimitrios J Richter; Patrick Schauerte; Miguel Sousa Uva; Giulio G Stefanini; David Paul Taggart; Lucia Torracca; Marco Valgimigli; William Wijns; Adam Witkowski; Jose Luis Zamorano; Stephan Achenbach; Helmut Baumgartner; Jeroen J Bax; Héctor Bueno; Veronica Dean; Christi Deaton; Çetin Erol; Robert Fagard; Roberto Ferrari; David Hasdai; Arno W Hoes; Paulus Kirchhof; Juhani Knuuti; Philippe Kolh; Patrizio Lancellotti; Ales Linhart; Petros Nihoyannopoulos; Massimo F Piepoli; Piotr Ponikowski; Per Anton Sirnes; Juan Luis Tamargo; Michal Tendera; Adam Torbicki; William Wijns; Stephan Windecker; Miguel Sousa Uva; Stephan Achenbach; John Pepper; Anelechi Anyanwu; Lina Badimon; Johann Bauersachs; Andreas Baumbach; Farzin Beygui; Nikolaos Bonaros; Marco De Carlo; Christi Deaton; Dobromir Dobrev; Joel Dunning; Eric Eeckhout; Stephan Gielen; David Hasdai; Paulus Kirchhof; Heyman Luckraz; Heiko Mahrholdt; Gilles Montalescot; Domenico Paparella; Ardawan J Rastan; Marcelo Sanmartin; Paul Sergeant; Sigmund Silber; Juan Tamargo; Jurrien ten Berg; Holger Thiele; Robert-Jan van Geuns; Hans-Otto Wagner; Sven Wassmann; Olaf Wendler; Jose Luis Zamorano Journal: Eur J Cardiothorac Surg Date: 2014-08-29 Impact factor: 4.191
Authors: Whady Hueb; Neuza H Lopes; Alexandre C Pereira; Alexandre C Hueb; Paulo Rogério Soares; Desidério Favarato; Ricardo D'Oliveira Vieira; Eduardo Gomes Lima; Cibele Larrosa Garzillo; Felipe da Silva Paulitch; Luiz A M César; Bernard J Gersh; José A F Ramires Journal: Circulation Date: 2010-09-14 Impact factor: 29.690
Authors: André Lamy; P J Devereaux; Dorairaj Prabhakaran; David P Taggart; Shengshou Hu; Ernesto Paolasso; Zbynek Straka; Leopoldo S Piegas; Ahmet Ruchan Akar; Anil R Jain; Nicolas Noiseux; Chandrasekar Padmanabhan; Juan-Carlos Bahamondes; Richard J Novick; Prashant Vaijyanath; Sukesh Kumar Reddy; Liang Tao; Pablo A Olavegogeascoechea; Balram Airan; Toomas-Andres Sulling; Richard P Whitlock; Yongning Ou; Janice Pogue; Susan Chrolavicius; Salim Yusuf Journal: N Engl J Med Date: 2013-03-11 Impact factor: 91.245
Authors: W Brent Keeling; Patrick D Kilgo; John D Puskas; Michael E Halkos; Omar M Lattouf; Robert A Guyton; Vinod H Thourani Journal: J Thorac Cardiovasc Surg Date: 2012-10-16 Impact factor: 5.209