AI Article Synopsis
- Recent studies indicate that off-pump coronary surgery is safe and effective for patients with critical left main stem stenosis, but previous research was limited in size and case mix adjustments.
- Between April 1997 and March 2003, a study involving 1,197 patients analyzed outcomes between off-pump (21.6%) and on-pump (78.4%) surgical techniques using statistical methods to account for patient differences.
- Results showed that off-pump surgery significantly reduced the need for inotropic support and hospital stay duration, with comparable long-term survival rates to on-pump techniques, suggesting it is a viable option for these patients.
Article Abstract
Background: Recent publications have shown coronary surgery is safe and effective in patients with critical left main stem stenosis when using off-pump coronary surgery techniques. However, these studies were small and did not adjust for differences in case mix.
Methods: Between April 1997 and March 2003, 1,197 consecutive patients with critical left main stem stenosis (> 50%) underwent coronary surgery. Two hundred and fifty-nine (21.6%) of these patients had off-pump coronary surgery, while 938 (78.4%) received on-pump coronary surgery. Multivariate logistic regression and Cox proportional hazards analysis were used to assess the effect of off-pump coronary surgery on outcomes, while adjusting for patient characteristics (treatment selection bias). Treatment selection bias was controlled by constructing a propensity score from core patient characteristics. The propensity score was the probability of receiving off-pump coronary surgery and was included along with the comparison variable in the multivariable analyses of outcome.
Results: After adjusting for the propensity score, the requirement for inotropic support (22.4% versus 35.3%; p < 0.001) or a prolonged length of stay (5.3% versus 9.3%; p = 0.034) were significantly reduced after receiving off-pump coronary surgery. There was a trend to suggest that off-pump patients had a lower incidence of stroke and chest infection. The adjusted freedom from death in off-pump patients at 2 years was 94.6% compared with 93.6% for on-pump patients (p = 0.54).
Conclusions: After risk adjustment, patients with critical left main stem stenosis can undergo off-pump coronary surgery safely, with results comparable with on-pump coronary surgery.
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| http://dx.doi.org/10.1016/j.athoracsur.2005.02.001 | DOI Listing |
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