Abstract
OBJECTIVES
The popularity of off pump coronary artery bypass grafting varies across the world, ranging from 20% in Europe and USA to 56% in Asia. We present the trend and early clinical outcomes in off pump in the United Kingdom.
METHOD
All patients who underwent elective or urgent isolated CABG from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. The trend in operating surgeons and units volume and training in off pump were analysed. Early clinical outcomes between off- and on pump Coronary Artery Bypass grafting were compared using propensity score matching.
RESULTS
A total 351422 patients were included. The overall off pump rate during the study period was 15.17%, it peaked in 2008 (19.8%), followed by a steady decreased to 2018 (7.63%). Its adoption varied across centres and surgeons, ranging from <1% to 48.36% and <1% to 85.5% respectively of total cases performed.
After propensity score matching for the period 1996–2019, off pump, when compared to on pump, was associated with a lower in-hospital/30 day mortality (1.2% vs 1.5%, p < 0.001), return to theatre (3.7% vs 4.5%, p < 0.001), cerebrovascular accident (Transient Ischaemic Attack: 0.3% vs 0.6%, Stroke: 0.3% vs 0.6%, p < 0.001) and deep sternal wound infection (0.8% vs 1.2%, p = <0.001). In a sub analysis from the introduction of Euroscore II (2012–2019) there was no differences in-hospital/30 day mortality [1.0% vs 1.0%, p = 0.71]. However, on pump, had a higher return to theatre [4.2% vs 2.7%, p < 0.001], cerebrovascular accident [Transient Ischaemic Attack: 0.4% vs 0.2%, Stroke: 0.5% vs 0.3%, p = 0.003] and deep sternal wound infection [1.0% vs 0.6%, p = 0.004].
CONCLUSION
Our data show a decreasing trend in the use of off pump in the UK since 2008. This is likely to be multifactorial and raises the question on whether it should be a specialized revascularisation technique.
The popularity of off pump coronary artery bypass grafting varies across the world, ranging from 20% in Europe and USA to 56% in Asia. We present the trend and early clinical outcomes in off pump in the United Kingdom.
METHOD
All patients who underwent elective or urgent isolated CABG from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. The trend in operating surgeons and units volume and training in off pump were analysed. Early clinical outcomes between off- and on pump Coronary Artery Bypass grafting were compared using propensity score matching.
RESULTS
A total 351422 patients were included. The overall off pump rate during the study period was 15.17%, it peaked in 2008 (19.8%), followed by a steady decreased to 2018 (7.63%). Its adoption varied across centres and surgeons, ranging from <1% to 48.36% and <1% to 85.5% respectively of total cases performed.
After propensity score matching for the period 1996–2019, off pump, when compared to on pump, was associated with a lower in-hospital/30 day mortality (1.2% vs 1.5%, p < 0.001), return to theatre (3.7% vs 4.5%, p < 0.001), cerebrovascular accident (Transient Ischaemic Attack: 0.3% vs 0.6%, Stroke: 0.3% vs 0.6%, p < 0.001) and deep sternal wound infection (0.8% vs 1.2%, p = <0.001). In a sub analysis from the introduction of Euroscore II (2012–2019) there was no differences in-hospital/30 day mortality [1.0% vs 1.0%, p = 0.71]. However, on pump, had a higher return to theatre [4.2% vs 2.7%, p < 0.001], cerebrovascular accident [Transient Ischaemic Attack: 0.4% vs 0.2%, Stroke: 0.5% vs 0.3%, p = 0.003] and deep sternal wound infection [1.0% vs 0.6%, p = 0.004].
CONCLUSION
Our data show a decreasing trend in the use of off pump in the UK since 2008. This is likely to be multifactorial and raises the question on whether it should be a specialized revascularisation technique.
| Original language | English |
|---|---|
| Article number | ezad272 |
| Journal | European Journal of Cardio-Thoracic Surgery |
| Volume | 64 |
| Issue number | 2 |
| Early online date | 31 Jul 2023 |
| DOIs | |
| Publication status | Published - 1 Aug 2023 |
Bibliographical note
Funding Information:The study was supported by the British Heart Foundation and the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol.
Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.