Objective: Non-elective coronary artery surgery (emergent/salvage or urgent) carries an increased risk in most risk-stratification models. Off-pump coronary surgery is increasingly used in non-elective cases. We aimed to investigate the effect of avoiding cardiopulmonary bypass on outcomes following non-elective coronary surgery.
Methods: Of the 3771 consecutive coronary artery bypass procedures performed by five surgeons between April 1997 and March 2002, 828 (22%) were non-elective and 417 (50.4%) of these patients had off-pump surgery. Multivariate logistic regression was used to assess the effect of off-pump on in-hospital outcomes, while adjusting for treatment selection bias. Treatment selection bias was controlled for by constructing a propensity score from core patient characteristics, which was the probability of avoiding cardiopulmonary bypass. The C statistic for this model was 0.8.
Results: Off-pump patients were more likely to be hypertensive, stable, had less extensive disease and better left ventricular function. The left internal mammary artery was used in 91.8% (n=383) of off-pump patients compared to 79.3% (n=326) of on-pump cases (P<0.001). After adjusting for the propensity score, no difference in in-hospital mortality was observed between off-pump and on-pump (adjusted odds ratio (OR) 0.83 (95% confidence intervals (CI) 0.36-1.93); P=0.667). Off-pump patients were less likely to require intra-aortic balloon pump support (adjusted OR 0.44 (95% CI 0.21-0.96); P=0.039), less likely to have renal failure (adjusted OR 0.44 (95% CI 0.22-0.90); P=0.025), and have shorter lengths of stay (adjusted OR 0.51 (95% CI 0.37-0.70); P<0.001). Other morbidity outcomes were similar in both groups.
Conclusions: In this experience, off-pump coronary surgery in non-elective patients is safe with acceptable results. Non-elective off-pump patients have a significantly reduced incidence of renal failure, and shorter post-operative stays compared to on-pump coronary artery bypass surgery.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/s1010-7940(03)00255-0 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Off-Pump Coronary Artery Bypass Grafting is Overutilized.
Semin Thorac Cardiovasc Surg
December 2024
Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048. Electronic address:
Off-pump coronary artery bypass grafting (CABG), developed to avoid the potential complications of cardiopulmonary bypass, remains a subject of debate. Studies have demonstrated that off-pump CABG is associated with higher rates of incomplete revascularization, inferior graft patency, and increased reintervention rates compared to on-pump CABG, leading to worse outcomes. The theoretical neuroprotective and renal-protective benefits associated with off-pump CABG have not been definitively proven, with stroke and renal failure rates similar to those of on-pump CABG in both short- and long-term follow-up.
View Article and Find Full Text PDFA technique avoiding cardioplegia delivery complications: a case using systemic hyperkalemia cardiopulmonary bypass combined with circulatory arrest.
J Extra Corpor Technol
December 2024
Department of Clinical Engineering, Kitaharima Medical Center, 926-250, Ichiba-cho, Ono-shi, Hyogo, 675-1392, Japan.
We conducted a high-risk redo mitral valve replacement through a right mini-thoracotomy without rib spreading (redo-MICS MVR) under systemic hyperkalemia combined with circulatory arrest to circumvent complications associated with cardioplegia delivery. The patient, a 75-year-old man, had a predicted mortality rate of 20%. Initial antegrade cardioplegia successfully induced cardiac arrest, which was administered every 30 min.
View Article and Find Full Text PDFCovered Stent Correction for Sinus Venosus Atrial Septal Defects, an Emerging Alternative to Surgical Repair: Results of an International Registry.
Circulation
December 2024
Department of Pediatrics, The Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (E.M.Z.).
Background: Covered stent correction for a sinus venosus atrial septal defect (SVASD) was first performed in 2009. This innovative approach was initially viewed as experimental and was reserved for highly selected patients with unusual anatomic variants. In 2016, increasing numbers of procedures began to be performed, and in several centers, it is now offered as a standard of care option alongside surgical repair.
View Article and Find Full Text PDFCurrent status of routine use of veno-arterial extracorporeal membrane oxygenation during lung transplantation.
Expert Rev Med Devices
December 2024
Department of Thoracic & Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
Article Synopsis
- There is increasing use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) during lung transplants, but protocols and outcomes are not yet standardized.
- The article discusses the rationale behind using VA ECMO, its protocols, applications, and overall impact on patient outcomes during lung transplantation.
- Evidence indicates that routine use of VA ECMO can reduce complications and improve early outcomes by enabling controlled reperfusion and preventing hemodynamic crises, but more research is needed for consensus on its best application.
Alternative Operative Strategy in the Management of an Atrio-Esophageal Fistula.
Cureus
November 2024
Department of Cardiothoracic Surgery, Sarasota Memorial Health Care System, Sarasota, USA.
An atrio-esophageal fistula is a rare sequela of ablation. Standard approaches are associated with a high mortality. Atrial ablation resulting in an atrio-esophageal fistula is associated with exceedingly high mortality.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!