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Off-pump versus on-pump coronary artery bypass grafting in consecutive patients: decision-making algorithm and outcomes.
Ann Thorac Surg. 2006 Feb; 81(2):555-61; discussion 561.AT

Abstract

BACKGROUND

Debate continues between on-pump or off-pump approach for coronary artery bypass grafting (CABG). We used off-pump coronary artery bypass grafting (OPCAB) as a tool within a decision-making algorithm driven by the patient-related factors of coronary anatomy and comorbidity. Our analysis presents this decision algorithm and describes outcomes using this approach.

METHODS

From January 2000 to December 2003, 592 consecutive patients undergoing isolated CABG were assigned by one surgeon to a technique: on-pump CABG or OPCAB according to (1) anatomy and (2) predicted risk. Anatomic factors against OPCAB were target vessel size less than 1.25 mm, calcification, poor quality, intramyocardial location, and multiple stenoses. Given that OPCAB could be performed safely, patients in the moderate risk range, ie, those elderly with multiple comorbidities, were preferentially treated using OPCAB.

RESULTS

The OPCAB group had higher predicted 30-day mortality compared with the on-pump CABG group, consistent with the protocol's intent. However, morbidity and mortality were similar between on-pump CABG and OPCAB. The OPCAB patients received the same number of internal mammary artery grafts but fewer distal grafts. Mortality and observed to expected ratios were favorable for both groups and below those The Society of Thoracic Surgeons' predicted for OPCAB.

CONCLUSIONS

Matching surgical strategy to patient-related factors and needs resulted in excellent outcomes. Our data support the use of a protocol based on patient characteristics to drive the surgeon's choice between an on-pump CABG or OPCAB approach. As such, OPCAB can be viewed as a tool to be used by the surgeon developing a best practice in treating coronary artery disease.

Authors+Show Affiliations

Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland 21201, USA. jbrown@smail.umaryland.eduNo 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
Comparative Study
Journal Article

Language

eng

PubMed ID

16427851

Citation

Brown, James M., et al. "Off-pump Versus On-pump Coronary Artery Bypass Grafting in Consecutive Patients: Decision-making Algorithm and Outcomes." The Annals of Thoracic Surgery, vol. 81, no. 2, 2006, pp. 555-61; discussion 561.
Brown JM, Poston RS, Gammie JS, et al. Off-pump versus on-pump coronary artery bypass grafting in consecutive patients: decision-making algorithm and outcomes. Ann Thorac Surg. 2006;81(2):555-61; discussion 561.
Brown, J. M., Poston, R. S., Gammie, J. S., Cardarelli, M. G., Schwartz, K., Sikora, J. A., Yi, S., Pierson, R. N., & Griffith, B. P. (2006). Off-pump versus on-pump coronary artery bypass grafting in consecutive patients: decision-making algorithm and outcomes. The Annals of Thoracic Surgery, 81(2), 555-61; discussion 561.
Brown JM, et al. Off-pump Versus On-pump Coronary Artery Bypass Grafting in Consecutive Patients: Decision-making Algorithm and Outcomes. Ann Thorac Surg. 2006;81(2):555-61; discussion 561. PubMed PMID: 16427851.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Off-pump versus on-pump coronary artery bypass grafting in consecutive patients: decision-making algorithm and outcomes. AU - Brown,James M, AU - Poston,Robert S, AU - Gammie,James S, AU - Cardarelli,Marcello G, AU - Schwartz,Kimberly, AU - Sikora,Jo Ann H, AU - Yi,Susan, AU - Pierson,Richard N,3rd AU - Griffith,Bartley P, PY - 2004/11/11/received PY - 2005/06/27/revised PY - 2005/06/28/accepted PY - 2006/1/24/pubmed PY - 2006/8/23/medline PY - 2006/1/24/entrez SP - 555-61; discussion 561 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 81 IS - 2 N2 - BACKGROUND: Debate continues between on-pump or off-pump approach for coronary artery bypass grafting (CABG). We used off-pump coronary artery bypass grafting (OPCAB) as a tool within a decision-making algorithm driven by the patient-related factors of coronary anatomy and comorbidity. Our analysis presents this decision algorithm and describes outcomes using this approach. METHODS: From January 2000 to December 2003, 592 consecutive patients undergoing isolated CABG were assigned by one surgeon to a technique: on-pump CABG or OPCAB according to (1) anatomy and (2) predicted risk. Anatomic factors against OPCAB were target vessel size less than 1.25 mm, calcification, poor quality, intramyocardial location, and multiple stenoses. Given that OPCAB could be performed safely, patients in the moderate risk range, ie, those elderly with multiple comorbidities, were preferentially treated using OPCAB. RESULTS: The OPCAB group had higher predicted 30-day mortality compared with the on-pump CABG group, consistent with the protocol's intent. However, morbidity and mortality were similar between on-pump CABG and OPCAB. The OPCAB patients received the same number of internal mammary artery grafts but fewer distal grafts. Mortality and observed to expected ratios were favorable for both groups and below those The Society of Thoracic Surgeons' predicted for OPCAB. CONCLUSIONS: Matching surgical strategy to patient-related factors and needs resulted in excellent outcomes. Our data support the use of a protocol based on patient characteristics to drive the surgeon's choice between an on-pump CABG or OPCAB approach. As such, OPCAB can be viewed as a tool to be used by the surgeon developing a best practice in treating coronary artery disease. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/16427851/Off_pump_versus_on_pump_coronary_artery_bypass_grafting_in_consecutive_patients:_decision_making_algorithm_and_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(05)01350-0 DB - PRIME DP - Unbound Medicine ER -