Impact of multiple arterial grafts in off-pump and on-pump coronary artery bypass surgery

Umberto Benedetto, Massimo Caputo, Gianni Angelini, Alan Bryan, Mario Gaudino, Giovanni Mariscalco

Research output: Contribution to journalArticle (Academic Journal)

7 Citations (Scopus)
258 Downloads (Pure)

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.
Original languageEnglish
Pages (from-to)300-309
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume153
Issue number2
Early online date16 Nov 2016
DOIs
Publication statusE-pub ahead of print - 16 Nov 2016

Structured keywords

  • Centre for Surgical Research

Fingerprint Dive into the research topics of 'Impact of multiple arterial grafts in off-pump and on-pump coronary artery bypass surgery'. Together they form a unique fingerprint.

  • Cite this