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Immediate and intermediate outcome after off-pump and on-pump coronary artery bypass surgery in patients with unstable angina pectoris.
Ann Thorac Surg. 2008 Oct; 86(4):1147-52.AT

Abstract

BACKGROUND

We have evaluated the immediate and intermediate outcome after off-pump (OPCAB) and conventional on-pump coronary artery bypass surgery (CCAB) in patients with unstable angina pectoris requiring nitrates infusion until arrival in the operating room.

METHODS

A consecutive series of 153 and 161 patients with unrelenting angina pectoris underwent CCAB and OPCAB, respectively. Conversion from OPCAB to beating heart surgery with perfusion occurred in 4 patients.

RESULTS

The OPCAB patients had a significantly higher operative risk than CCAB patients (logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE]: 13.8 +/- 12.8% vs 10.5 +/- 10.0%, p = 0.005). In the overall series, a lower 30-day postoperative mortality was observed among OPCAB patients (1.9% vs 3.9%, p = 0.33), the difference increased along the logistic EuroSCORE tertiles (upper tertile: 3.2% vs 9.5%, p = 0.14), but failed to reach statistical significance. Similar results have been observed among one-to-one propensity score matched pairs. The results of three surgeons who treated most of their patients (96.9%) with OPCAB were compared with those of three surgeons who used, in most of cases (97.1%), the CCAB technique. When adjusted for logistic EuroSCORE, patients operated on by CCAB surgeons had a significantly higher 30-day postoperative mortality (7.1% vs 2.1%, p = 0.04; odds ratio [OR] 10.143; 95% confidence interval [CI] 1.084 to 94.945) as well as a higher risk of combined adverse events (47.1% vs. 35.1%, p = 0.009; OR 2.586; 95% CI 1.274 to 5.250).

CONCLUSIONS

This study provided further evidence on the safety and efficacy of OPCAB in the treatment of high-risk patients. A dedicated approach to OPCAB seems to provide particularly good results. Such findings further support a more confident approach with OPCAB in these patients.

Authors+Show Affiliations

Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.itNo 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
Journal Article

Language

eng

PubMed ID

18805150

Citation

Biancari, Fausto, et al. "Immediate and Intermediate Outcome After Off-pump and On-pump Coronary Artery Bypass Surgery in Patients With Unstable Angina Pectoris." The Annals of Thoracic Surgery, vol. 86, no. 4, 2008, pp. 1147-52.
Biancari F, Mahar MA, Mosorin M, et al. Immediate and intermediate outcome after off-pump and on-pump coronary artery bypass surgery in patients with unstable angina pectoris. Ann Thorac Surg. 2008;86(4):1147-52.
Biancari, F., Mahar, M. A., Mosorin, M., Heikkinen, J., Pokela, M., Taskinen, P., Anttila, V., Lahtinen, J., & Lepojärvi, M. (2008). Immediate and intermediate outcome after off-pump and on-pump coronary artery bypass surgery in patients with unstable angina pectoris. The Annals of Thoracic Surgery, 86(4), 1147-52. https://doi.org/10.1016/j.athoracsur.2008.05.037
Biancari F, et al. Immediate and Intermediate Outcome After Off-pump and On-pump Coronary Artery Bypass Surgery in Patients With Unstable Angina Pectoris. Ann Thorac Surg. 2008;86(4):1147-52. PubMed PMID: 18805150.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immediate and intermediate outcome after off-pump and on-pump coronary artery bypass surgery in patients with unstable angina pectoris. AU - Biancari,Fausto, AU - Mahar,Muhammad Ali Asim, AU - Mosorin,Martti, AU - Heikkinen,Jouni, AU - Pokela,Matti, AU - Taskinen,Panu, AU - Anttila,Vesa, AU - Lahtinen,Jarmo, AU - Lepojärvi,Martti, PY - 2008/03/18/received PY - 2008/05/10/revised PY - 2008/05/15/accepted PY - 2008/9/23/pubmed PY - 2008/10/23/medline PY - 2008/9/23/entrez SP - 1147 EP - 52 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 86 IS - 4 N2 - BACKGROUND: We have evaluated the immediate and intermediate outcome after off-pump (OPCAB) and conventional on-pump coronary artery bypass surgery (CCAB) in patients with unstable angina pectoris requiring nitrates infusion until arrival in the operating room. METHODS: A consecutive series of 153 and 161 patients with unrelenting angina pectoris underwent CCAB and OPCAB, respectively. Conversion from OPCAB to beating heart surgery with perfusion occurred in 4 patients. RESULTS: The OPCAB patients had a significantly higher operative risk than CCAB patients (logistic European System for Cardiac Operative Risk Evaluation [EuroSCORE]: 13.8 +/- 12.8% vs 10.5 +/- 10.0%, p = 0.005). In the overall series, a lower 30-day postoperative mortality was observed among OPCAB patients (1.9% vs 3.9%, p = 0.33), the difference increased along the logistic EuroSCORE tertiles (upper tertile: 3.2% vs 9.5%, p = 0.14), but failed to reach statistical significance. Similar results have been observed among one-to-one propensity score matched pairs. The results of three surgeons who treated most of their patients (96.9%) with OPCAB were compared with those of three surgeons who used, in most of cases (97.1%), the CCAB technique. When adjusted for logistic EuroSCORE, patients operated on by CCAB surgeons had a significantly higher 30-day postoperative mortality (7.1% vs 2.1%, p = 0.04; odds ratio [OR] 10.143; 95% confidence interval [CI] 1.084 to 94.945) as well as a higher risk of combined adverse events (47.1% vs. 35.1%, p = 0.009; OR 2.586; 95% CI 1.274 to 5.250). CONCLUSIONS: This study provided further evidence on the safety and efficacy of OPCAB in the treatment of high-risk patients. A dedicated approach to OPCAB seems to provide particularly good results. Such findings further support a more confident approach with OPCAB in these patients. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/18805150/Immediate_and_intermediate_outcome_after_off_pump_and_on_pump_coronary_artery_bypass_surgery_in_patients_with_unstable_angina_pectoris_ DB - PRIME DP - Unbound Medicine ER -