Comparison between off- and on-pump coronary artery bypass grafting: long-term results of a real-world registry
| Autor: | Tiziano Gherli, Claudio Zussa, Rossana De Palma, Davide Gabbieri, Daniela Fortuna, Giovanni Andrea Contini, Antonella Vezzani, Davide Pacini, Francesco Nicolini |
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| Přispěvatelé: | Nicolini F, Fortuna D, Contini GA, Pacini D, Gabbieri D, Zussa C, De Palma R, Vezzani A, Gherli T |
| Rok vydání: | 2015 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty medicine.medical_treatment Population Coronary Artery Bypass Off-Pump Coronary artery bypass grafting Off-pump Coronary Artery Disease 030204 cardiovascular system & hematology Revascularization law.invention 03 medical and health sciences 0302 clinical medicine Postoperative Complications law Risk Factors Internal medicine Cause of Death medicine Cardiopulmonary bypass Humans Myocardial infarction Registries Coronary Artery Bypass education Propensity Score Stroke Aged Retrospective Studies Aged 80 and over education.field_of_study Ejection fraction business.industry General Medicine Perioperative Cardiac surgery medicine.disease Survival Rate 030228 respiratory system Italy Cardiology Surgery Female Cardiology and Cardiovascular Medicine business Follow-Up Studies Forecasting |
| Zdroj: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 50(3) |
| ISSN: | 1873-734X |
| Popis: | OBJECTIVES: The aim of this study was to compare 5-year rates of overall death, cardiac-related death, myocardial infarction, repeat revascularization, stroke and new occurrence of postoperative renal failure in a large cohort of patients with coronary disease, treated with on- or off-pump coronary artery bypass grafting (CABG). METHODS: Two propensity score-matched cohorts, each of 560 patients, undergoing isolated surgical coronary revascularization at the regional public and private centres of Emilia-Romagna region (Italy) over the period 1 January 2003 - 31 December 2013, were used to compare long-term outcomes of on-pump CABG (6711 patients) and off-pump CABG (597 patients). RESULTS: The matched on-pump group received significantly more bypass grafts than the matched off-pump group (2.4 ± 1.1 vs 1.6 ± 0.9, P < 0.0001). The on-pump group reported statistically significant lower cardiac-related mortality. There was a trend towards higher overall mortality and the need for repeat revascularization procedures in the off-pump group. No difference was found for myocardial infarction, stroke or new occurrence of postoperative renal failure between groups in the follow-up. The multivariate analysis of significant predictors of mortality in the overall population confirmed that the off-pump revascularization strategy was an independent predictor of death at long-term follow-up. On-pump CABG reported significantly better results in terms of mortality in the subgroups of patients with a depressed left ventricular ejection fraction and in patients with three-vessel disease. CONCLUSIONS: In patients undergoing elective isolated CABG, on-pump strategy conferred a long-term survival advantage compared with off-pump strategy, particularly for patients with more extensive coronary disease. No benefits were found in terms of reduction of postoperative morbidity with the off-pump strategy. On-pump surgery should be the preferred revascularization technique, and off-pump surgery reserved for patients for whom the perioperative risk of cardiopulmonary bypass is greater than the risk of a less complete coronary revascularization. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. |
| Databáze: | OpenAIRE |
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