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Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: a case control study.
Circulation. 2003 Sep 09; 108 Suppl 1:II15-20.Circ

Abstract

BACKGROUND

Patients with severe atheromatous aortic disease (AAD) who undergo coronary artery bypass (CABG) have an increased risk of death and stroke. We hypothesized that in these high risk patients, off-pump coronary artery bypass (OPCAB) technique is associated with lower morbidity and mortality.

METHODS AND RESULTS

Between June 1993 and January 2002, 5737 patients undergoing CABG had routine intra-operative TEE with 913 (15.9%) found to have severe AAD in the aortic arch or ascending aorta. Of these, 211 patients who underwent OPCAB were matched with 211 on-pump CABG patients by age, ejection fraction, history of stroke, cerebrovascular disease, diabetes, renal disease, nonelective operation, and previous cardiac surgery. Hospital mortality was 11.4% (24/211) for on-pump CABG and 3.8% (8/211) for OPCAB (P=0.003). Multivariate analysis revealed that increased mortality was associated with on-pump CABG (P=0.001), acute MI (P=0.03), number of grafts (P=0.01), age (P=0.01), history of stroke or cerebrovascular disease (P=0.04), CHF (P=0.02), and peripheral vascular disease (P=0.03). Multivariate analysis showed that OPCAB technique was associated with decreased stroke (P=0.05). Freedom from any complication was 78.7% for on-pump CABG and 91.9% for OPCAB (P<0.001). At 36 month follow-up multivariate analysis revealed that increased mortality was associated with age (P=0.001), previous MI (P=0.03), and renal disease (P=0.04), whereas increased survival was associated with increased number of grafts (P=0.001) and OPCAB (P=0.01).

CONCLUSIONS

OPCAB surgery in patients with severe AAD is associated with lower risk of death, stroke and complications and improved mid-term survival. Routine intra-operative TEE allows identification of these patients and directs choice of appropriate surgical technique.

Authors+Show Affiliations

Division of Cardiothoracic Surgery, Department of Anesthesiology, New York University School of Medicine, New York, NY, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12970201

Citation

Sharony, Ram, et al. "Off-pump Coronary Artery Bypass Grafting Reduces Mortality and Stroke in Patients With Atheromatous Aortas: a Case Control Study." Circulation, vol. 108 Suppl 1, 2003, pp. II15-20.
Sharony R, Bizekis CS, Kanchuger M, et al. Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: a case control study. Circulation. 2003;108 Suppl 1:II15-20.
Sharony, R., Bizekis, C. S., Kanchuger, M., Galloway, A. C., Saunders, P. C., Applebaum, R., Schwartz, C. F., Ribakove, G. H., Culliford, A. T., Baumann, F. G., Kronzon, I., Colvin, S. B., & Grossi, E. A. (2003). Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: a case control study. Circulation, 108 Suppl 1, II15-20.
Sharony R, et al. Off-pump Coronary Artery Bypass Grafting Reduces Mortality and Stroke in Patients With Atheromatous Aortas: a Case Control Study. Circulation. 2003 Sep 9;108 Suppl 1:II15-20. PubMed PMID: 12970201.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: a case control study. AU - Sharony,Ram, AU - Bizekis,Costas S, AU - Kanchuger,Marc, AU - Galloway,Aubrey C, AU - Saunders,Paul C, AU - Applebaum,Robert, AU - Schwartz,Charles F, AU - Ribakove,Greg H, AU - Culliford,Alfred T, AU - Baumann,F Gregory, AU - Kronzon,Itzhak, AU - Colvin,Stephen B, AU - Grossi,Eugene A, PY - 2003/9/13/pubmed PY - 2003/10/1/medline PY - 2003/9/13/entrez SP - II15 EP - 20 JF - Circulation JO - Circulation VL - 108 Suppl 1 N2 - BACKGROUND: Patients with severe atheromatous aortic disease (AAD) who undergo coronary artery bypass (CABG) have an increased risk of death and stroke. We hypothesized that in these high risk patients, off-pump coronary artery bypass (OPCAB) technique is associated with lower morbidity and mortality. METHODS AND RESULTS: Between June 1993 and January 2002, 5737 patients undergoing CABG had routine intra-operative TEE with 913 (15.9%) found to have severe AAD in the aortic arch or ascending aorta. Of these, 211 patients who underwent OPCAB were matched with 211 on-pump CABG patients by age, ejection fraction, history of stroke, cerebrovascular disease, diabetes, renal disease, nonelective operation, and previous cardiac surgery. Hospital mortality was 11.4% (24/211) for on-pump CABG and 3.8% (8/211) for OPCAB (P=0.003). Multivariate analysis revealed that increased mortality was associated with on-pump CABG (P=0.001), acute MI (P=0.03), number of grafts (P=0.01), age (P=0.01), history of stroke or cerebrovascular disease (P=0.04), CHF (P=0.02), and peripheral vascular disease (P=0.03). Multivariate analysis showed that OPCAB technique was associated with decreased stroke (P=0.05). Freedom from any complication was 78.7% for on-pump CABG and 91.9% for OPCAB (P<0.001). At 36 month follow-up multivariate analysis revealed that increased mortality was associated with age (P=0.001), previous MI (P=0.03), and renal disease (P=0.04), whereas increased survival was associated with increased number of grafts (P=0.001) and OPCAB (P=0.01). CONCLUSIONS: OPCAB surgery in patients with severe AAD is associated with lower risk of death, stroke and complications and improved mid-term survival. Routine intra-operative TEE allows identification of these patients and directs choice of appropriate surgical technique. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/12970201/Off_pump_coronary_artery_bypass_grafting_reduces_mortality_and_stroke_in_patients_with_atheromatous_aortas:_a_case_control_study_ L2 - https://www.ahajournals.org/doi/10.1161/01.cir.0000087448.65888.21?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -