title: Off-pump coronary artery bypass grafting reduces mortality and stroke in patients with atheromatous aortas: a case control study.
abstract: BACKGROUND
  Patients with severe atheromatous aortic disease (AAD) who undergo coronary artery bypass (CABG) have an increased risk of death and stroke. We hypothesized that in these high risk patients, off-pump coronary artery bypass (OPCAB) technique is associated with lower morbidity and mortality.
  
  
  RESULTS
  Between June 1993 and January 2002, 5737 patients undergoing CABG had routine intra-operative TEE with 913 (15.9%) found to have severe AAD in the aortic arch or ascending aorta. Of these, 211 patients who underwent OPCAB were matched with 211 on-pump CABG patients by age, ejection fraction, history of stroke, cerebrovascular disease, diabetes, renal disease, nonelective operation, and previous cardiac surgery. Hospital mortality was 11.4% (24/211) for on-pump CABG and 3.8% (8/211) for OPCAB (P=0.003). Multivariate analysis revealed that increased mortality was associated with on-pump CABG (P=0.001), acute MI (P=0.03), number of grafts (P=0.01), age (P=0.01), history of stroke or cerebrovascular disease (P=0.04), CHF (P=0.02), and peripheral vascular disease (P=0.03). Multivariate analysis showed that OPCAB technique was associated with decreased stroke (P=0.05). Freedom from any complication was 78.7% for on-pump CABG and 91.9% for OPCAB (P<0.001). At 36 month follow-up multivariate analysis revealed that increased mortality was associated with age (P=0.001), previous MI (P=0.03), and renal disease (P=0.04), whereas increased survival was associated with increased number of grafts (P=0.001) and OPCAB (P=0.01).
  
  
  CONCLUSIONS
  OPCAB surgery in patients with severe AAD is associated with lower risk of death, stroke and complications and improved mid-term survival. Routine intra-operative TEE allows identification of these patients and directs choice of appropriate surgical technique.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Anesthesiology, New York University School of Medicine, New York, NY, USA.
authors.forename: Ram
authors.initials: R
authors.lastname: Sharony
authors.forename: Costas S
authors.initials: CS
authors.lastname: Bizekis
authors.forename: Marc
authors.initials: M
authors.lastname: Kanchuger
authors.forename: Aubrey C
authors.initials: AC
authors.lastname: Galloway
authors.forename: Paul C
authors.initials: PC
authors.lastname: Saunders
authors.forename: Robert
authors.initials: R
authors.lastname: Applebaum
authors.forename: Charles F
authors.initials: CF
authors.lastname: Schwartz
authors.forename: Greg H
authors.initials: GH
authors.lastname: Ribakove
authors.forename: Alfred T
authors.initials: AT
authors.lastname: Culliford
authors.forename: F Gregory
authors.initials: FG
authors.lastname: Baumann
authors.forename: Itzhak
authors.initials: I
authors.lastname: Kronzon
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Colvin
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000150:complications*; D001161:Arteriosclerosis / Q000150:complications*; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*