Conversion after off-pump coronary artery bypass grafting: the CORONARY trial experience
| Autor: | Yongning Ou, Horacio Cacheda, Louis-Mathieu Stevens, Dharma Rakshak Ayapati, Coronary investigators, Andre Lamy, Sirish Parvathaneni, Alvaro Avezum, Xin Chen, Fernando Antonio Lucchese, Nicolas Noiseux |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Blood transfusion medicine.medical_treatment Coronary Artery Bypass Off-Pump Kaplan-Meier Estimate 030204 cardiovascular system & hematology law.invention Intraoperative Period 03 medical and health sciences Coronary artery bypass surgery 0302 clinical medicine Double-Blind Method Risk Factors law Internal medicine medicine Humans Myocardial infarction Coronary Artery Bypass Intraoperative Complications Stroke Dialysis Aged Off-pump coronary artery bypass Cardiopulmonary Bypass Intraoperative Care business.industry General Medicine Middle Aged medicine.disease Intensive care unit Treatment Outcome 030228 respiratory system Cardiology Female Surgery Hemodialysis Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. :ezw361 |
| ISSN: | 1873-734X 1010-7940 |
| DOI: | 10.1093/ejcts/ezw361 |
| Popis: | Objectives Emergent and late conversions form OFF-to-ON pump coronary artery bypass grafting (CABG) have been associated with worse outcomes, however, it remains unclear as to which risk factors are associated with conversion and how to prevent them. Methods Among 4718 patients who randomly underwent off- or on-pump CABG, the incidence of off-pump to on-pump cross-over, or 'OFF-to-ON conversion', was 7.9% (186/2356). The primary outcome was a composite of death, stroke, myocardial infarction, or new renal failure requiring dialysis. We assessed the risk factors and outcomes of converted patients. Results Emergent OFF-to-ON conversions, defined as conversions for hypotension or ischaemia, were required for 3.2% of patients ( n = 75), while most elective conversions were due to small or intramuscular coronaries ( n = 83). OFF-to-ON converted patients required increased surgery time, blood transfusions, intensive care unit stay, and presented a higher incidence at 1 year of the composite outcome compared with non-converted off-pump patients (all P < 0.01), especially if the conversion was emergent. Conversely, elective conversions outcomes were no different compared with non-converted off-pump patients ( P = 0.35). Independent predictors of emergent conversions included higher heart rate or chronic atrial fibrillation, urgent surgery, more grafts planned and surgeon experience with off-pump CABG. Conclusions Emergent OFF-to-ON conversion is associated with worse outcomes compared with elective conversion or no conversion. In the presence of risk factors for emergent conversion, an early and elective conversion approach is a judicious strategy. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|