Complete revascularization is compromised in off-pump coronary artery bypass grafting
Objective Patients who undergo off-pump coronary artery bypass grafting (OPCAB) commonly receive fewer bypass grafts and are more often incompletely revascularized compared with those receiving conventional coronary artery bypass (CCAB) recipients. Because this can compromise survival, we sought to...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2013-04, Vol.145 (4), p.992-998 |
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| container_title | The Journal of thoracic and cardiovascular surgery |
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| creator | Robertson, Mark W., BSc Buth, Karen J., MSc Stewart, Keir M., MD Wood, Jeremy R., MD Sullivan, John A., MD Hirsch, Gregory M., MD Hancock Friesen, Camille L., MD |
| description | Objective Patients who undergo off-pump coronary artery bypass grafting (OPCAB) commonly receive fewer bypass grafts and are more often incompletely revascularized compared with those receiving conventional coronary artery bypass (CCAB) recipients. Because this can compromise survival, we sought to determine whether patients undergoing OPCAB are incompletely revascularized and whether this affects long-term survival and freedom from cardiac events. Methods OPCAB cases (n = 411) performed from January 1, 1997 to June 30, 2003 were considered for inclusion and matching with 874 randomly selected, contemporary CCAB cases. After propensity matching, 308 OPCAB cases and 308 CCAB cases were included in the final analysis. We compared the number of bypass grafts and the completeness of revascularization by coronary territory. Survival and readmission for cardiac causes were monitored for up to 10 years postoperatively, with a median follow-up period of 5.9 years. Results On average, the patients undergoing OPCAB received significantly fewer distal anastomoses than did those undergoing CCAB (mean ± standard deviation, 2.6 ± 0.9 vs 3.0 ± 1.0, P |
| doi_str_mv | 10.1016/j.jtcvs.2012.03.052 |
| format | Article |
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Because this can compromise survival, we sought to determine whether patients undergoing OPCAB are incompletely revascularized and whether this affects long-term survival and freedom from cardiac events. Methods OPCAB cases (n = 411) performed from January 1, 1997 to June 30, 2003 were considered for inclusion and matching with 874 randomly selected, contemporary CCAB cases. After propensity matching, 308 OPCAB cases and 308 CCAB cases were included in the final analysis. We compared the number of bypass grafts and the completeness of revascularization by coronary territory. Survival and readmission for cardiac causes were monitored for up to 10 years postoperatively, with a median follow-up period of 5.9 years. Results On average, the patients undergoing OPCAB received significantly fewer distal anastomoses than did those undergoing CCAB (mean ± standard deviation, 2.6 ± 0.9 vs 3.0 ± 1.0, P < .0001). The circumflex territory was the most likely territory to be ungrafted during OPCAB in patients with angiographically significant obstruction ( P = .0006). The frequency of complete revascularization was significantly different between the 2 groups (OPCAB, 79.2% vs CCAB, 88.3%; P = .0.002). The OPCAB group had a significantly greater rate of total arterial grafting (OPCAB, 66.6% vs CCAB, 49.7%; P = .0001). No difference was seen in 8-year survival or freedom from cardiac cause hospital readmission between the 2 groups. Conclusions Despite receiving fewer distal anastomoses and the decreased frequency of complete revascularization, OPCAB and CCAB techniques produced comparable results.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2012.03.052</identifier><identifier>PMID: 22513317</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Cardiothoracic Surgery ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2013-04, Vol.145 (4), p.992-998</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2013 The American Association for Thoracic Surgery</rights><rights>Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-e4e185ce9152026fcc907ecfadb657b3d7ea603bf2d666e50c6057ee3bed814b3</citedby><cites>FETCH-LOGICAL-c525t-e4e185ce9152026fcc907ecfadb657b3d7ea603bf2d666e50c6057ee3bed814b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2012.03.052$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22513317$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Robertson, Mark W., BSc</creatorcontrib><creatorcontrib>Buth, Karen J., MSc</creatorcontrib><creatorcontrib>Stewart, Keir M., MD</creatorcontrib><creatorcontrib>Wood, Jeremy R., MD</creatorcontrib><creatorcontrib>Sullivan, John A., MD</creatorcontrib><creatorcontrib>Hirsch, Gregory M., MD</creatorcontrib><creatorcontrib>Hancock Friesen, Camille L., MD</creatorcontrib><title>Complete revascularization is compromised in off-pump coronary artery bypass grafting</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective Patients who undergo off-pump coronary artery bypass grafting (OPCAB) commonly receive fewer bypass grafts and are more often incompletely revascularized compared with those receiving conventional coronary artery bypass (CCAB) recipients. Because this can compromise survival, we sought to determine whether patients undergoing OPCAB are incompletely revascularized and whether this affects long-term survival and freedom from cardiac events. Methods OPCAB cases (n = 411) performed from January 1, 1997 to June 30, 2003 were considered for inclusion and matching with 874 randomly selected, contemporary CCAB cases. After propensity matching, 308 OPCAB cases and 308 CCAB cases were included in the final analysis. We compared the number of bypass grafts and the completeness of revascularization by coronary territory. Survival and readmission for cardiac causes were monitored for up to 10 years postoperatively, with a median follow-up period of 5.9 years. Results On average, the patients undergoing OPCAB received significantly fewer distal anastomoses than did those undergoing CCAB (mean ± standard deviation, 2.6 ± 0.9 vs 3.0 ± 1.0, P < .0001). The circumflex territory was the most likely territory to be ungrafted during OPCAB in patients with angiographically significant obstruction ( P = .0006). The frequency of complete revascularization was significantly different between the 2 groups (OPCAB, 79.2% vs CCAB, 88.3%; P = .0.002). The OPCAB group had a significantly greater rate of total arterial grafting (OPCAB, 66.6% vs CCAB, 49.7%; P = .0001). No difference was seen in 8-year survival or freedom from cardiac cause hospital readmission between the 2 groups. Conclusions Despite receiving fewer distal anastomoses and the decreased frequency of complete revascularization, OPCAB and CCAB techniques produced comparable results.</description><subject>Cardiothoracic Surgery</subject><subject>Coronary Artery Bypass</subject><subject>Coronary Artery Bypass, Off-Pump</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1L7DAUhoMoOn78AuHSpZvWk8SknYWCDH6B4EIH3IU0PZX0tk1v0g6Mv96Mo3fhxtWBk_fNOe9zCDmlkFGg8rzJmtGsQsaAsgx4BoLtkBmFeZ7KQrzukhkAY6lgjB-QwxAaAMiBzvfJAWOCck7zGVkuXDe0OGLicaWDmVrt7bseresTGxITX73rbMAqsX3i6jodpm6Ife967deJ9iPGUq4HHULy5nU92v7tmOzVug148lWPyPL25mVxnz4-3T0srh9TI5gYU7xAWgiDcyoYMFkbM4ccTa2rUoq85FWOWgIva1ZJKVGAkSByRF5iVdCLkh-Rs-2_ccl_E4ZRxVUNtq3u0U1B0ZixEKKgRZTyrdR4F4LHWg3edjGCoqA2PFWjPnmqDU8FXEWe0fXna8BUdlj993wDjILLrQBjzJVFr4Kx2BusrEczqsrZXwZc_fCb1vbW6PYvrjE0bvJ9JKioCtGjnjcn3VyUMgCes4J_AMR9nos</recordid><startdate>20130401</startdate><enddate>20130401</enddate><creator>Robertson, Mark W., BSc</creator><creator>Buth, Karen J., MSc</creator><creator>Stewart, Keir M., MD</creator><creator>Wood, Jeremy R., MD</creator><creator>Sullivan, John A., MD</creator><creator>Hirsch, Gregory M., MD</creator><creator>Hancock Friesen, Camille L., MD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130401</creationdate><title>Complete revascularization is compromised in off-pump coronary artery bypass grafting</title><author>Robertson, Mark W., BSc ; Buth, Karen J., MSc ; Stewart, Keir M., MD ; Wood, Jeremy R., MD ; Sullivan, John A., MD ; Hirsch, Gregory M., MD ; Hancock Friesen, Camille L., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-e4e185ce9152026fcc907ecfadb657b3d7ea603bf2d666e50c6057ee3bed814b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Cardiothoracic Surgery</topic><topic>Coronary Artery Bypass</topic><topic>Coronary Artery Bypass, Off-Pump</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Robertson, Mark W., BSc</creatorcontrib><creatorcontrib>Buth, Karen J., MSc</creatorcontrib><creatorcontrib>Stewart, Keir M., MD</creatorcontrib><creatorcontrib>Wood, Jeremy R., MD</creatorcontrib><creatorcontrib>Sullivan, John A., MD</creatorcontrib><creatorcontrib>Hirsch, Gregory M., MD</creatorcontrib><creatorcontrib>Hancock Friesen, Camille L., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Robertson, Mark W., BSc</au><au>Buth, Karen J., MSc</au><au>Stewart, Keir M., MD</au><au>Wood, Jeremy R., MD</au><au>Sullivan, John A., MD</au><au>Hirsch, Gregory M., MD</au><au>Hancock Friesen, Camille L., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complete revascularization is compromised in off-pump coronary artery bypass grafting</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2013-04-01</date><risdate>2013</risdate><volume>145</volume><issue>4</issue><spage>992</spage><epage>998</epage><pages>992-998</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Objective Patients who undergo off-pump coronary artery bypass grafting (OPCAB) commonly receive fewer bypass grafts and are more often incompletely revascularized compared with those receiving conventional coronary artery bypass (CCAB) recipients. Because this can compromise survival, we sought to determine whether patients undergoing OPCAB are incompletely revascularized and whether this affects long-term survival and freedom from cardiac events. Methods OPCAB cases (n = 411) performed from January 1, 1997 to June 30, 2003 were considered for inclusion and matching with 874 randomly selected, contemporary CCAB cases. After propensity matching, 308 OPCAB cases and 308 CCAB cases were included in the final analysis. We compared the number of bypass grafts and the completeness of revascularization by coronary territory. Survival and readmission for cardiac causes were monitored for up to 10 years postoperatively, with a median follow-up period of 5.9 years. Results On average, the patients undergoing OPCAB received significantly fewer distal anastomoses than did those undergoing CCAB (mean ± standard deviation, 2.6 ± 0.9 vs 3.0 ± 1.0, P < .0001). The circumflex territory was the most likely territory to be ungrafted during OPCAB in patients with angiographically significant obstruction ( P = .0006). The frequency of complete revascularization was significantly different between the 2 groups (OPCAB, 79.2% vs CCAB, 88.3%; P = .0.002). The OPCAB group had a significantly greater rate of total arterial grafting (OPCAB, 66.6% vs CCAB, 49.7%; P = .0001). No difference was seen in 8-year survival or freedom from cardiac cause hospital readmission between the 2 groups. Conclusions Despite receiving fewer distal anastomoses and the decreased frequency of complete revascularization, OPCAB and CCAB techniques produced comparable results.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>22513317</pmid><doi>10.1016/j.jtcvs.2012.03.052</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Cardiothoracic Surgery Coronary Artery Bypass Coronary Artery Bypass, Off-Pump Female Humans Male Middle Aged Retrospective Studies Treatment Outcome |
| title | Complete revascularization is compromised in off-pump coronary artery bypass grafting |
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