Ten-year outcomes after off-pump versus on-pump coronary artery bypass grafting:Insights from the Arterial Revascularization Trial
| Autor: | Taggart, DP, Gaudino, MF, Gerry, S, Gray, A, Lees, B, Sajja, LR, Zamvar, V, Flather, M, Benedetto, U, Investigators, Arterial Revascularization Trial |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors off-pump Bristol Heart Institute Coronary Artery Bypass Off-Pump Coronary Artery Disease Internal thoracic artery 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors medicine.artery Internal medicine Post-hoc analysis medicine Humans Myocardial infarction Coronary Artery Bypass Stroke CABG Randomized Controlled Trials as Topic Retrospective Studies Cardiopulmonary Bypass Proportional hazards model business.industry on-pump Hazard ratio medicine.disease Confidence interval arterial revascularization Treatment Outcome 030228 respiratory system Propensity score matching Cardiology Female Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | Taggart, D P, Gaudino, M F, Gerry, S, Gray, A, Lees, B, Sajja, L R, Samvar, V, Flather, M & Benedetto, U 2020, ' Ten-year outcomes after off-pump versus on-pump coronary artery bypass grafting : Insights from the Arterial Revascularization Trial ', Journal of Thoracic and Cardiovascular Surgery . https://doi.org/10.1016/j.jtcvs.2020.02.035 |
| Popis: | Objective We performed a post hoc analysis of the Arterial Revascularization Trial to compare 10-year outcomes after off-pump versus on-pump surgery. Methods Among 3102 patients enrolled, 1252 (40% of total) and 1699 patients received off-pump and on-pump surgery (151 patients were excluded because of other reasons); 2792 patients (95%) completed 10-year follow-up. Propensity matching and mixed-effect Cox model were used to compare long-term outcomes. Interaction term analysis was used to determine whether bilateral internal thoracic artery grafting was a significant effect modifier. Results One thousand seventy-eight matched pairs were selected for comparison. A total of 27 patients (2.5%) in the off-pump group required conversion to on-pump surgery. The off-pump and on-pump groups received a similar number of grafts (3.2 ± 0.89 vs 3.1 ± 0.8; P = .88). At 10 years, when compared with on-pump, there was no significant difference in death (adjusted hazard ratio for off-pump, 1.1; 95% confidence interval, 0.84-1.4; P = .54) or the composite of death, myocardial infarction, stroke, and repeat revascularization (adjusted hazard ratio, 0.92; 95% confidence interval, 0.72-1.2; P = .47). However, off-pump surgery performed by low volume off-pump surgeons was associated with a significantly lower number of grafts, increased conversion rates, and increased cardiovascular death (hazard ratio, 2.39; 95% confidence interval, 1.28-4.47; P = .006) when compared with on-pump surgery performed by on–pump-only surgeons. Conclusions The findings showed that in the Arterial Revascularization Trial, off-pump and on-pump techniques achieved comparable long-term outcomes. However, when off-pump surgery was performed by low-volume surgeons, it was associated with a lower number of grafts, increased conversion, and a higher risk of cardiovascular death. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|