Off-pump versus on-pump coronary artery bypass grafting in patients with left ventricular dysfunction

Chikara Ueki, Hiroaki Miyata, Noboru Motomura, Genichi Sakaguchi, Takehide Akimoto, Shinichi Takamoto

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective Using data from the Japan Adult Cardiovascular Surgery Database, we evaluated the prognostic influence of off-pump technique in patients with low ejection fraction who underwent coronary artery bypass grafting. Methods We analyzed 2187 patients with an ejection fraction <0.30 who underwent primary, nonemergency, isolated coronary artery bypass grafting between 2008 and 2012, as reported in the Japan Adult Cardiovascular Surgery Database. Patients were divided into on-pump (n = 1134; 51.1%) and off-pump (n = 1053; 48.9%) coronary artery bypass grafting groups. Propensity-score matching for 20 preoperative variables was performed, and early mortality and morbidity were compared between matched groups. Results Propensity-score matching created 918 pairs. Of the 918 patients in the off-pump group, conversion to an on-pump procedure occurred in 56 (6.1%). Compared with on-pump, off-pump technique was associated with significantly lower incidences of 30-day death (1.7% vs 3.7%; P =.01), operative death (3.3% vs 6.1%; P =.006), mediastinitis (1.9% vs 3.4%; P =.041), reoperation for bleeding (0.9% vs 3.5%; P <.001), and prolonged ventilation (8.2% vs 13.4%; P <.001). Comparison of patients undergoing off-pump versus on-pump procedures demonstrated no significant differences in the incidence of stroke (1.5% vs 2.1%; P =.38), renal failure (6.1% vs 7.4%; P =.26), and postoperative dialysis (3.1% vs 4.4%; P =.14). Institutional volume-adjusted analysis confirmed most of these results. Conclusions Off-pump coronary artery bypass grafting is associated with significantly reduced early mortality and morbidity in patients with an ejection fraction <0.30.

Original languageEnglish
Pages (from-to)1092-1098
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume151
Issue number4
DOIs
Publication statusPublished - 2016 Apr 1
Externally publishedYes

Fingerprint

Left Ventricular Dysfunction
Coronary Artery Bypass
Propensity Score
Japan
Databases
Morbidity
Off-Pump Coronary Artery Bypass
Mediastinitis
Mortality
Incidence
Reoperation
Renal Insufficiency
Ventilation
Dialysis
Research Design
Stroke
Hemorrhage

Keywords

  • left ventricular dysfunction
  • off-pump coronary artery bypass grafting
  • on-pump coronary artery bypass grafting
  • propensity score

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Off-pump versus on-pump coronary artery bypass grafting in patients with left ventricular dysfunction. / Ueki, Chikara; Miyata, Hiroaki; Motomura, Noboru; Sakaguchi, Genichi; Akimoto, Takehide; Takamoto, Shinichi.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 151, No. 4, 01.04.2016, p. 1092-1098.

Research output: Contribution to journalArticle

Ueki, Chikara ; Miyata, Hiroaki ; Motomura, Noboru ; Sakaguchi, Genichi ; Akimoto, Takehide ; Takamoto, Shinichi. / Off-pump versus on-pump coronary artery bypass grafting in patients with left ventricular dysfunction. In: Journal of Thoracic and Cardiovascular Surgery. 2016 ; Vol. 151, No. 4. pp. 1092-1098.
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abstract = "Objective Using data from the Japan Adult Cardiovascular Surgery Database, we evaluated the prognostic influence of off-pump technique in patients with low ejection fraction who underwent coronary artery bypass grafting. Methods We analyzed 2187 patients with an ejection fraction <0.30 who underwent primary, nonemergency, isolated coronary artery bypass grafting between 2008 and 2012, as reported in the Japan Adult Cardiovascular Surgery Database. Patients were divided into on-pump (n = 1134; 51.1{\%}) and off-pump (n = 1053; 48.9{\%}) coronary artery bypass grafting groups. Propensity-score matching for 20 preoperative variables was performed, and early mortality and morbidity were compared between matched groups. Results Propensity-score matching created 918 pairs. Of the 918 patients in the off-pump group, conversion to an on-pump procedure occurred in 56 (6.1{\%}). Compared with on-pump, off-pump technique was associated with significantly lower incidences of 30-day death (1.7{\%} vs 3.7{\%}; P =.01), operative death (3.3{\%} vs 6.1{\%}; P =.006), mediastinitis (1.9{\%} vs 3.4{\%}; P =.041), reoperation for bleeding (0.9{\%} vs 3.5{\%}; P <.001), and prolonged ventilation (8.2{\%} vs 13.4{\%}; P <.001). Comparison of patients undergoing off-pump versus on-pump procedures demonstrated no significant differences in the incidence of stroke (1.5{\%} vs 2.1{\%}; P =.38), renal failure (6.1{\%} vs 7.4{\%}; P =.26), and postoperative dialysis (3.1{\%} vs 4.4{\%}; P =.14). Institutional volume-adjusted analysis confirmed most of these results. Conclusions Off-pump coronary artery bypass grafting is associated with significantly reduced early mortality and morbidity in patients with an ejection fraction <0.30.",
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AU - Akimoto, Takehide

AU - Takamoto, Shinichi

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N2 - Objective Using data from the Japan Adult Cardiovascular Surgery Database, we evaluated the prognostic influence of off-pump technique in patients with low ejection fraction who underwent coronary artery bypass grafting. Methods We analyzed 2187 patients with an ejection fraction <0.30 who underwent primary, nonemergency, isolated coronary artery bypass grafting between 2008 and 2012, as reported in the Japan Adult Cardiovascular Surgery Database. Patients were divided into on-pump (n = 1134; 51.1%) and off-pump (n = 1053; 48.9%) coronary artery bypass grafting groups. Propensity-score matching for 20 preoperative variables was performed, and early mortality and morbidity were compared between matched groups. Results Propensity-score matching created 918 pairs. Of the 918 patients in the off-pump group, conversion to an on-pump procedure occurred in 56 (6.1%). Compared with on-pump, off-pump technique was associated with significantly lower incidences of 30-day death (1.7% vs 3.7%; P =.01), operative death (3.3% vs 6.1%; P =.006), mediastinitis (1.9% vs 3.4%; P =.041), reoperation for bleeding (0.9% vs 3.5%; P <.001), and prolonged ventilation (8.2% vs 13.4%; P <.001). Comparison of patients undergoing off-pump versus on-pump procedures demonstrated no significant differences in the incidence of stroke (1.5% vs 2.1%; P =.38), renal failure (6.1% vs 7.4%; P =.26), and postoperative dialysis (3.1% vs 4.4%; P =.14). Institutional volume-adjusted analysis confirmed most of these results. Conclusions Off-pump coronary artery bypass grafting is associated with significantly reduced early mortality and morbidity in patients with an ejection fraction <0.30.

AB - Objective Using data from the Japan Adult Cardiovascular Surgery Database, we evaluated the prognostic influence of off-pump technique in patients with low ejection fraction who underwent coronary artery bypass grafting. Methods We analyzed 2187 patients with an ejection fraction <0.30 who underwent primary, nonemergency, isolated coronary artery bypass grafting between 2008 and 2012, as reported in the Japan Adult Cardiovascular Surgery Database. Patients were divided into on-pump (n = 1134; 51.1%) and off-pump (n = 1053; 48.9%) coronary artery bypass grafting groups. Propensity-score matching for 20 preoperative variables was performed, and early mortality and morbidity were compared between matched groups. Results Propensity-score matching created 918 pairs. Of the 918 patients in the off-pump group, conversion to an on-pump procedure occurred in 56 (6.1%). Compared with on-pump, off-pump technique was associated with significantly lower incidences of 30-day death (1.7% vs 3.7%; P =.01), operative death (3.3% vs 6.1%; P =.006), mediastinitis (1.9% vs 3.4%; P =.041), reoperation for bleeding (0.9% vs 3.5%; P <.001), and prolonged ventilation (8.2% vs 13.4%; P <.001). Comparison of patients undergoing off-pump versus on-pump procedures demonstrated no significant differences in the incidence of stroke (1.5% vs 2.1%; P =.38), renal failure (6.1% vs 7.4%; P =.26), and postoperative dialysis (3.1% vs 4.4%; P =.14). Institutional volume-adjusted analysis confirmed most of these results. Conclusions Off-pump coronary artery bypass grafting is associated with significantly reduced early mortality and morbidity in patients with an ejection fraction <0.30.

KW - left ventricular dysfunction

KW - off-pump coronary artery bypass grafting

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KW - propensity score

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