Edgar Aranda-Michel1, Valentino Bianco1, Arman Kilic2, Thomas G Gleason2, Forozan Navid2, Ibrahim Sultan3. 1. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, United States of America. 2. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, United States of America; Heart and Vascular Institute, University of Pittsburgh Medical Center, United States of America. 3. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, United States of America; Heart and Vascular Institute, University of Pittsburgh Medical Center, United States of America. Electronic address: sultani@upmc.edu.
Abstract
INTRODUCTION: Large institutional and administrative datasets that have compared on pump versus off pump first time coronary artery bypass grafting (CABG). However, comparison of off-pump vs on-pump outcomes in patients undergoing redo CABG are limited in current literature. METHODS: All patients who underwent redo CABG for coronary artery disease from 2011 to 2017 at our institution were included in the study. Cox regression analysis was performed to identify variables associated with 5-year mortality and readmission. RESULTS: Three hundred and fifty patients underwent redo CABG; of which, 309 underwent on-pump CABG and 41 underwent off-pump CABG. Blood product transfusion (31.7% vs 58.9%; p = 0.001) and new onset atrial fibrillation (17.1% vs 35.6%; p = 0.018) were higher in the on-pump cohort. There was no difference in 30-day (2.4% vs 8.1%; p = 0.209), 1-year (4.9% vs 16.5%; p = 0.074), or 5-year mortality (31.7% vs 35.6%; p = 0.213) for off vs on pump redo CABG. There was no difference in 30-day or 1- hospital readmissions between groups. Five-year all cause readmissions (76.9% vs 55.3%; p = 0.037) was significantly higher in the off-pump redo CABG group. On multivariable analysis, on vs. off pump CABG was not significantly associated with mortality or readmission at 5 years. CONCLUSION: There was no short or long-term survival advantage for on-pump vs off-pump CABG despite risk adjustment. Hospital readmissions at 5-years were higher in the off-pump group.
INTRODUCTION: Large institutional and administrative datasets that have compared on pump versus off pump first time coronary artery bypass grafting (CABG). However, comparison of off-pump vs on-pump outcomes in patients undergoing redo CABG are limited in current literature. METHODS: All patients who underwent redo CABG for coronary artery disease from 2011 to 2017 at our institution were included in the study. Cox regression analysis was performed to identify variables associated with 5-year mortality and readmission. RESULTS: Three hundred and fifty patients underwent redo CABG; of which, 309 underwent on-pump CABG and 41 underwent off-pump CABG. Blood product transfusion (31.7% vs 58.9%; p = 0.001) and new onset atrial fibrillation (17.1% vs 35.6%; p = 0.018) were higher in the on-pump cohort. There was no difference in 30-day (2.4% vs 8.1%; p = 0.209), 1-year (4.9% vs 16.5%; p = 0.074), or 5-year mortality (31.7% vs 35.6%; p = 0.213) for off vs on pump redo CABG. There was no difference in 30-day or 1- hospital readmissions between groups. Five-year all cause readmissions (76.9% vs 55.3%; p = 0.037) was significantly higher in the off-pump redo CABG group. On multivariable analysis, on vs. off pump CABG was not significantly associated with mortality or readmission at 5 years. CONCLUSION: There was no short or long-term survival advantage for on-pump vs off-pump CABG despite risk adjustment. Hospital readmissions at 5-years were higher in the off-pump group.
Authors: Richard A E Ramsingh; Jean-Luc Duval; Natasha C Rahaman; Risshi D Rampersad; Gianni D Angelini; Giovanni Teodori Journal: J Card Surg Date: 2020-08-26 Impact factor: 1.778