title: Influence of on-pump versus off-pump techniques and completeness of revascularization on long-term survival after coronary artery bypass.
abstract: BACKGROUND
  Off-pump coronary artery bypass graft surgery (OPCABG) may be associated with reduced morbidity and in-hospital mortality. In this study, we report the influence of surgery type, number of grafts, and the Index of Completeness of Revascularization (ICOR), namely, the number of grafts/number diseased vessel systems, on long-term survival.
  
  
  METHODS
  From 1997 to 2006, 12,812 consecutive patients underwent isolated CABG at a single academic center. Ten-year survival data were obtained by cross-referencing patients with the national Social Security Death Index. A propensity score analysis of 46 preoperative characteristics balanced risk factors between surgical groups. A proportional hazards regression analysis modeled the hazard of death as a function of surgery type (on versus off), distal group (1 to 3 versus 4 to 7 vessels), ICOR, and propensity score.
  
  
  RESULTS
  Proportional hazards regression analysis showed no significant influence of surgery type or number of grafts on long-term survival within the four groups: OPCABG 1 to 3 grafts (n = 3,946; ICOR 1.11), OPCABG 4 to 7 grafts (n = 1,721; ICOR 1.56), on-pump CABG 1 to 3 grafts (n = 3,380; ICOR 1.21), and on-pump CABG 4 to 7 grafts (n = 3,765; ICOR 1.64). Irrespective of technique of revascularization, there was a survival advantage for patients with higher ICOR.
  
  
  CONCLUSIONS
  Long-term survival was similar for patients receiving 1 to 3 or 4 to 7 grafts by either on-pump or off-pump techniques. However, higher ICOR was associated with improved long- term survival within all groups.
authors: Joseph B. Whitehead Department of Surgery, Division of Cardiothoracic Surgery, Carlyle Fraser Heart Center, Cardiothoracic Surgery Clinical Research Unit, Atlanta, Georgia, USA. omar.lattouf@emoryhealthcare.org
authors: Omar M
authors: OM
authors: Lattouf
authors: Vinod H
authors: VH
authors: Thourani
authors: Patrick D
authors: PD
authors: Kilgo
authors: Michael E
authors: ME
authors: Halkos
authors: Kim T
authors: KT
authors: Baio
authors: Richard
authors: R
authors: Myung
authors: William A
authors: WA
authors: Cooper
authors: Robert A
authors: RA
authors: Guyton
authors: John D
authors: JD
authors: Puskas
mesh_terms: D002315:Cardiopulmonary Bypass / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome