Influence of on-pump versus off-pump techniques and completeness of revascularization on long-term survival after coronary artery bypass.
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.
Lattouf
Omar M
OM
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
Thourani
Vinod H
VH
Kilgo
Patrick D
PD
Halkos
Michael E
ME
Baio
Kim T
KT
Myung
Richard
R
Cooper
William A
WA
Guyton
Robert A
RA
Puskas
John D
JD
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