Propensity score analysis of early and late outcome after redo off-pump and on-pump coronary artery bypass grafting.
BACKGROUND
The purpose of this study was to compare early and late results of redo-CABG with (redo-ONCAB) and without (redo-OPCAB) cardiopulmonary bypass.


METHODS
From April 2001 to September 2006 redo-CABG was performed in 110 patients (redo-ONCAB=50 and redo-OPCAB=60). Applying the propensity score, 43 OPCAB patients were matched with 43 ONCAB patients. The mean EuroScore was 5+/-4.7 and 5+/-3.4 for redo-ONCAB and redo-OPCAB, respectively (p=0.5). The number of diseased coronary arteries was 3+/-0.5 and 2+/-0.8 in redo-ONCAB and redo-OPCAB, respectively (p<0.01).


RESULTS
Twelve patients underwent OPCAB through anterior thoracotomy while the rest of the patients (n=74) underwent median sternotomy. Mean number of grafts performed was 3+/-0.8 in redo-ONCAB and 2+/-0.6 in redo-OPCAB (p<0.05). The need for postoperative insertion of intra-aortic balloon pump (IABP) was higher (p=0.02) in redo-ONCAB (n=9, 21%) than redo-OPCAB (n=1, 2%). The duration of postoperative ventilation was 55+/-98.7 h for redo-ONCAB and 10+/-12.8h for redo-OPCAB (p=0.008). No differences were found in the incidence of other postoperative complications. The 30-day mortality rate was 6.9% for redo-ONCAB (n=3) and 2.3% redo-OPCAB (n=1; p=NS). Mean follow-up for redo-ONCAB was 30+/-21.3 months (range 0.1-63 months) and that of redo-OPCAB was 37+/-19.2 months (0.1-62.5 months). Actuarial survival at 5 years was 87+/-5.5% for redo-ONCAB and 95+/-3.2% for redo-OPCAB (p=0.17). Event-free survival was 71+/-8.0% for redo-ONCAB and 78+/-7.2% for redo-OPCAB (p=0.32).


CONCLUSIONS
OPCAB is an acceptable strategy in selected patients requiring redo-CABG. Employing a strategy of OPCAB for those patients with 2 or fewer lesions and ONCAB for those with more diffuse disease, redo-OPCAB and redo-ONCAB have similar early and late outcomes.
Vohra
Hunaid A
HA
Department of Cardiac Surgery, Harefield Hospital, Royal Brompton & Harefield Hospitals NHS Trust, London, United Kingdom.
Bahrami
Toufan
T
Farid
Shakil
S
Mafi
Ahmed
A
Dreyfus
Gilles
G
Amrani
Mohammad
M
Gaer
Jullien A R
JA
D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome