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Off-pump versus on-pump coronary artery bypass graft surgery: differences in short-term outcomes and in long-term mortality and need for subsequent revascularization.
Circulation. 2007 Sep 04; 116(10):1145-52.Circ

Abstract

BACKGROUND

Off-pump coronary artery bypass graft surgery (OPCAB) has been performed for many years, but its use is increasing in frequency, and it remains an open question whether OPCAB is associated with better outcomes than on-pump coronary artery bypass graft (CABG) surgery.

METHODS AND RESULTS

New York State patients who underwent either OPCAB with median sternotomy (13 889 patients) or on-pump CABG surgery (35 941 patients) between 2001 and 2004 were followed up via New York databases. Short- and long-term outcomes were compared after adjustment for patient risk factors and after patients were matched on the basis of significant predictors of type of CABG surgery. OPCAB had a significantly lower inpatient/30-day mortality rate (adjusted OR 0.81, 95% confidence interval [CI] 0.68 to 0.97), lower rates for 2 perioperative complications (stroke: adjusted OR 0.70, 95% CI 0.57 to 0.86; respiratory failure: adjusted OR 0.80, 95% CI 0.68 to 0.93), and a higher rate of unplanned operation in the same admission (adjusted OR 1.47, 95% CI 1.01 to 2.15). In the matched samples, no difference existed in 3-year mortality (hazard ratio 1.08, 95% CI 0.96 to 1.22), but OPCAB patients had higher rates of subsequent revascularization (hazard ratio 1.55, 95% CI 1.33 to 1.80). The 3-year OPCAB and on-pump survival rates for matched patients were 89.4% and 90.1%, respectively (P=0.20). For freedom from subsequent revascularization, the respective rates were 89.9% and 93.6% (P<0.0001).

CONCLUSIONS

OPCAB is associated with lower in-hospital mortality and complication rates than on-pump CABG, but long-term outcomes are comparable, except for freedom from revascularization, which favors on-pump CABG.

Authors+Show Affiliations

State University of New York at Albany, Department of Health Policy, Management, and Behavior, One University Place, Rensselaer, NY 12144, USA. elh03@health.state.ny.us.No 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
Journal Article

Language

eng

PubMed ID

17709642

Citation

Hannan, Edward L., et al. "Off-pump Versus On-pump Coronary Artery Bypass Graft Surgery: Differences in Short-term Outcomes and in Long-term Mortality and Need for Subsequent Revascularization." Circulation, vol. 116, no. 10, 2007, pp. 1145-52.
Hannan EL, Wu C, Smith CR, et al. Off-pump versus on-pump coronary artery bypass graft surgery: differences in short-term outcomes and in long-term mortality and need for subsequent revascularization. Circulation. 2007;116(10):1145-52.
Hannan, E. L., Wu, C., Smith, C. R., Higgins, R. S., Carlson, R. E., Culliford, A. T., Gold, J. P., & Jones, R. H. (2007). Off-pump versus on-pump coronary artery bypass graft surgery: differences in short-term outcomes and in long-term mortality and need for subsequent revascularization. Circulation, 116(10), 1145-52.
Hannan EL, et al. Off-pump Versus On-pump Coronary Artery Bypass Graft Surgery: Differences in Short-term Outcomes and in Long-term Mortality and Need for Subsequent Revascularization. Circulation. 2007 Sep 4;116(10):1145-52. PubMed PMID: 17709642.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Off-pump versus on-pump coronary artery bypass graft surgery: differences in short-term outcomes and in long-term mortality and need for subsequent revascularization. AU - Hannan,Edward L, AU - Wu,Chuntao, AU - Smith,Craig R, AU - Higgins,Robert S D, AU - Carlson,Russell E, AU - Culliford,Alfred T, AU - Gold,Jeffrey P, AU - Jones,Robert H, Y1 - 2007/08/20/ PY - 2007/8/22/pubmed PY - 2007/10/12/medline PY - 2007/8/22/entrez SP - 1145 EP - 52 JF - Circulation JO - Circulation VL - 116 IS - 10 N2 - BACKGROUND: Off-pump coronary artery bypass graft surgery (OPCAB) has been performed for many years, but its use is increasing in frequency, and it remains an open question whether OPCAB is associated with better outcomes than on-pump coronary artery bypass graft (CABG) surgery. METHODS AND RESULTS: New York State patients who underwent either OPCAB with median sternotomy (13 889 patients) or on-pump CABG surgery (35 941 patients) between 2001 and 2004 were followed up via New York databases. Short- and long-term outcomes were compared after adjustment for patient risk factors and after patients were matched on the basis of significant predictors of type of CABG surgery. OPCAB had a significantly lower inpatient/30-day mortality rate (adjusted OR 0.81, 95% confidence interval [CI] 0.68 to 0.97), lower rates for 2 perioperative complications (stroke: adjusted OR 0.70, 95% CI 0.57 to 0.86; respiratory failure: adjusted OR 0.80, 95% CI 0.68 to 0.93), and a higher rate of unplanned operation in the same admission (adjusted OR 1.47, 95% CI 1.01 to 2.15). In the matched samples, no difference existed in 3-year mortality (hazard ratio 1.08, 95% CI 0.96 to 1.22), but OPCAB patients had higher rates of subsequent revascularization (hazard ratio 1.55, 95% CI 1.33 to 1.80). The 3-year OPCAB and on-pump survival rates for matched patients were 89.4% and 90.1%, respectively (P=0.20). For freedom from subsequent revascularization, the respective rates were 89.9% and 93.6% (P<0.0001). CONCLUSIONS: OPCAB is associated with lower in-hospital mortality and complication rates than on-pump CABG, but long-term outcomes are comparable, except for freedom from revascularization, which favors on-pump CABG. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/17709642/Off_pump_versus_on_pump_coronary_artery_bypass_graft_surgery:_differences_in_short_term_outcomes_and_in_long_term_mortality_and_need_for_subsequent_revascularization_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.106.675595?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -