Abstract
OBJECTIVES:
There is growing concern that off-pump coronary artery bypass (OPCAB) is associated with reduced long-term survival compared with traditional on-pump coronary artery bypass (ONCAB); however, most of available comparisons between OPCAB and ONCAB focus on single-artery (SA) revascularization. We sought to investigate the impact of using multiple arterial (MA) conduits in the comparison between OPCAB versus ONCAB by performing a single-center, long-term propensity score base analysis.
METHODS:
The study population included 5195 SA-ONCAB, 1208 MA-ONCAB, 4412 SA-OPCAB, and 1818 MA-OPCAB procedures. Late survival was available for all cases (100%). Inverse propensity score weighting and a time-segmented Cox model were used for multiple treatments comparison.
RESULTS:
No significant differences were found between the 4 groups in terms of 30-day mortality, postoperative cerebrovascular accident, and renal replacement therapy. After a mean follow-up time of 8.2 ± 4.7 years, in the propensity score-weighted sample, survival probabilities at 10 years were 74.5 ± 0.4, 79.7 ± 0.4, 73.4 ± 0.5, and 79.0 ± 0.5 in the SA-ONCAB, MA-ONCAB, SA-OPCAB, and MA-OPCAB groups respectively. Propensity-weighted analysis confirmed that MA-OPCAB (hazard ratio, 0.81; 95% confidence interval, 0.69-0.98) and MA-ONCAB (hazard ratio, 0.81; 95% confidence interval, 0.65-0.99) were associated with a lower late mortality compared with standard SA-ONCAB.
CONCLUSIONS:
OPCAB with multiple arterial grafts is as safe as the conventional ONCAB and achieves excellent long term survival rates which are superior to those observed after standard SA-ONCAB and comparable with MA-ONCAB.
There is growing concern that off-pump coronary artery bypass (OPCAB) is associated with reduced long-term survival compared with traditional on-pump coronary artery bypass (ONCAB); however, most of available comparisons between OPCAB and ONCAB focus on single-artery (SA) revascularization. We sought to investigate the impact of using multiple arterial (MA) conduits in the comparison between OPCAB versus ONCAB by performing a single-center, long-term propensity score base analysis.
METHODS:
The study population included 5195 SA-ONCAB, 1208 MA-ONCAB, 4412 SA-OPCAB, and 1818 MA-OPCAB procedures. Late survival was available for all cases (100%). Inverse propensity score weighting and a time-segmented Cox model were used for multiple treatments comparison.
RESULTS:
No significant differences were found between the 4 groups in terms of 30-day mortality, postoperative cerebrovascular accident, and renal replacement therapy. After a mean follow-up time of 8.2 ± 4.7 years, in the propensity score-weighted sample, survival probabilities at 10 years were 74.5 ± 0.4, 79.7 ± 0.4, 73.4 ± 0.5, and 79.0 ± 0.5 in the SA-ONCAB, MA-ONCAB, SA-OPCAB, and MA-OPCAB groups respectively. Propensity-weighted analysis confirmed that MA-OPCAB (hazard ratio, 0.81; 95% confidence interval, 0.69-0.98) and MA-ONCAB (hazard ratio, 0.81; 95% confidence interval, 0.65-0.99) were associated with a lower late mortality compared with standard SA-ONCAB.
CONCLUSIONS:
OPCAB with multiple arterial grafts is as safe as the conventional ONCAB and achieves excellent long term survival rates which are superior to those observed after standard SA-ONCAB and comparable with MA-ONCAB.
| Original language | English |
|---|---|
| Pages (from-to) | 300-309 |
| Number of pages | 9 |
| Journal | Journal of Thoracic and Cardiovascular Surgery |
| Volume | 153 |
| Issue number | 2 |
| Early online date | 16 Nov 2016 |
| DOIs | |
| Publication status | E-pub ahead of print - 16 Nov 2016 |
Research Groups and Themes
- Centre for Surgical Research