Tags

Type your tag names separated by a space and hit enter

Propensity case-matched analysis of off-pump coronary artery bypass grafting in patients with atheromatous aortic disease.
J Thorac Cardiovasc Surg. 2004 Feb; 127(2):406-13.JT

Abstract

OBJECTIVE

Atheromatous aortic disease is a risk factor for excessive mortality and stroke in patients undergoing coronary artery bypass grafting. Outcomes of off-pump coronary artery bypass grafting and coronary artery bypass grafting with cardiopulmonary bypass in patients with severe atheromatous aortic disease were compared by propensity case-match methods.

METHODS

Routine intraoperative transesophageal echocardiography identified 985 patients undergoing isolated coronary artery bypass grafting with severe atheromatous disease in the aortic arch or ascending aorta. Off-pump coronary artery bypass grafting was performed in 281 patients (28.5%). Propensity matched-pairs analysis was used to match patients undergoing off-pump coronary artery bypass grafting (n = 245) with patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.

RESULTS

Univariate analysis revealed decreased hospital mortality (16/245, 6.5% vs 28/245, 11.4%; P =.058) and stroke prevalence (4/245, 1.6% vs 14/245, 5.7%; P =.03) in off-pump coronary artery bypass grafting compared with coronary artery bypass grafting with cardiopulmonary bypass. Freedom from any postoperative complication was higher in off-pump coronary artery bypass grafting compared with coronary artery bypass grafting with cardiopulmonary bypass (226/245, 92.2% vs 196/245, 80.0%; P <.001). Multivariable analysis of preoperative risk factors showed that increased hospital mortality was associated with coronary artery bypass grafting with cardiopulmonary bypass (odds ratio = 2.7; P =.01), fewer grafts (P =.05), acute myocardial infarction (odds ratio = 11.5; P <.001), chronic obstructive pulmonary disease (odds ratio = 2.4; P =.03), previous cardiac surgery (odds ratio = 10.2, P =.05), and peripheral vascular disease (odds ratio = 2.1; P =.05). Cardiopulmonary bypass was the only independent risk factor for stroke (odds ratio = 3.6, P =.03). At 36 months' follow-up, comparable survival was observed in the off-pump coronary artery bypass grafting and coronary artery bypass grafting with cardiopulmonary bypass groups (74% vs 72%). Multivariable analysis revealed that renal disease (P <.001), advanced age (P <.001), previous myocardial infarction (P =.03), and lower number of grafts (P =.02) were independent risks for late mortality.

CONCLUSIONS

Patients with severe atherosclerotic aortic disease who undergo off-pump coronary artery bypass grafting have a significantly lower prevalence of hospital mortality, perioperative stroke, and overall complications than matched patients who underwent coronary artery bypass grafting with cardiopulmonary bypass. Routine intraoperative transesophageal echocardiography identifies severe atheromatous aortic disease and directs the choice of surgical technique.

Authors+Show Affiliations

Department of Surgery, New York University School of Medicine, New York, 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 available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14762348

Citation

Sharony, Ram, et al. "Propensity Case-matched Analysis of Off-pump Coronary Artery Bypass Grafting in Patients With Atheromatous Aortic Disease." The Journal of Thoracic and Cardiovascular Surgery, vol. 127, no. 2, 2004, pp. 406-13.
Sharony R, Grossi EA, Saunders PC, et al. Propensity case-matched analysis of off-pump coronary artery bypass grafting in patients with atheromatous aortic disease. J Thorac Cardiovasc Surg. 2004;127(2):406-13.
Sharony, R., Grossi, E. A., Saunders, P. C., Galloway, A. C., Applebaum, R., Ribakove, G. H., Culliford, A. T., Kanchuger, M., Kronzon, I., & Colvin, S. B. (2004). Propensity case-matched analysis of off-pump coronary artery bypass grafting in patients with atheromatous aortic disease. The Journal of Thoracic and Cardiovascular Surgery, 127(2), 406-13.
Sharony R, et al. Propensity Case-matched Analysis of Off-pump Coronary Artery Bypass Grafting in Patients With Atheromatous Aortic Disease. J Thorac Cardiovasc Surg. 2004;127(2):406-13. PubMed PMID: 14762348.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Propensity case-matched analysis of off-pump coronary artery bypass grafting in patients with atheromatous aortic disease. AU - Sharony,Ram, AU - Grossi,Eugene A, AU - Saunders,Paul C, AU - Galloway,Aubrey C, AU - Applebaum,Robert, AU - Ribakove,Greg H, AU - Culliford,Alfred T, AU - Kanchuger,Marc, AU - Kronzon,Itzhak, AU - Colvin,Stephen B, PY - 2004/2/6/pubmed PY - 2004/5/27/medline PY - 2004/2/6/entrez SP - 406 EP - 13 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 127 IS - 2 N2 - OBJECTIVE: Atheromatous aortic disease is a risk factor for excessive mortality and stroke in patients undergoing coronary artery bypass grafting. Outcomes of off-pump coronary artery bypass grafting and coronary artery bypass grafting with cardiopulmonary bypass in patients with severe atheromatous aortic disease were compared by propensity case-match methods. METHODS: Routine intraoperative transesophageal echocardiography identified 985 patients undergoing isolated coronary artery bypass grafting with severe atheromatous disease in the aortic arch or ascending aorta. Off-pump coronary artery bypass grafting was performed in 281 patients (28.5%). Propensity matched-pairs analysis was used to match patients undergoing off-pump coronary artery bypass grafting (n = 245) with patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. RESULTS: Univariate analysis revealed decreased hospital mortality (16/245, 6.5% vs 28/245, 11.4%; P =.058) and stroke prevalence (4/245, 1.6% vs 14/245, 5.7%; P =.03) in off-pump coronary artery bypass grafting compared with coronary artery bypass grafting with cardiopulmonary bypass. Freedom from any postoperative complication was higher in off-pump coronary artery bypass grafting compared with coronary artery bypass grafting with cardiopulmonary bypass (226/245, 92.2% vs 196/245, 80.0%; P <.001). Multivariable analysis of preoperative risk factors showed that increased hospital mortality was associated with coronary artery bypass grafting with cardiopulmonary bypass (odds ratio = 2.7; P =.01), fewer grafts (P =.05), acute myocardial infarction (odds ratio = 11.5; P <.001), chronic obstructive pulmonary disease (odds ratio = 2.4; P =.03), previous cardiac surgery (odds ratio = 10.2, P =.05), and peripheral vascular disease (odds ratio = 2.1; P =.05). Cardiopulmonary bypass was the only independent risk factor for stroke (odds ratio = 3.6, P =.03). At 36 months' follow-up, comparable survival was observed in the off-pump coronary artery bypass grafting and coronary artery bypass grafting with cardiopulmonary bypass groups (74% vs 72%). Multivariable analysis revealed that renal disease (P <.001), advanced age (P <.001), previous myocardial infarction (P =.03), and lower number of grafts (P =.02) were independent risks for late mortality. CONCLUSIONS: Patients with severe atherosclerotic aortic disease who undergo off-pump coronary artery bypass grafting have a significantly lower prevalence of hospital mortality, perioperative stroke, and overall complications than matched patients who underwent coronary artery bypass grafting with cardiopulmonary bypass. Routine intraoperative transesophageal echocardiography identifies severe atheromatous aortic disease and directs the choice of surgical technique. SN - 0022-5223 UR - https://www.unboundmedicine.com/medline/citation/14762348/Propensity_case_matched_analysis_of_off_pump_coronary_artery_bypass_grafting_in_patients_with_atheromatous_aortic_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022522303015034 DB - PRIME DP - Unbound Medicine ER -