High OPCAB surgical volume improves midterm event-free survival.
BACKGROUND
The aim of this study was to evaluate the midterm results of the initial phase of off-pump coronary artery bypass (OPCAB) surgery adoption in a single surgical unit, assessing the impact of procedural volume.


METHODS
Study participants were 312 patients who underwent OPCAB during the period between August 2000 and January 2005 at S. Croce Hospital. Of these patients, 126 patients with an indication selected for comorbidities or 1-vessel disease underwent OPCAB performed by 4 low-volume surgeons, and 186 unselected patients underwent OPCAB performed by a single high-volume surgeon.


RESULTS
OPCAB performed by low-volume surgeons was associated with less complete revascularization and less arterial conduit use. Early result analysis showed a low rate of in-hospital or 30-day adverse events. The 5-year survival was 0.88 (0.02 SE). OPCAB performance by a high-volume surgeon and complete revascularization were shown have a protective effect for midterm major adverse cardiac events (respectively, hazard ratio = 0.28, 95% confidence interval 0.11-0.74 and hazard ratio = 0.33, 95% confidence interval 0.15-0.73).


CONCLUSIONS
Our study on the initial phase of OPCAB adoption suggests a benefit on midterm outcome from surgery performed by a high-volume surgeon.
Agostini
Marco
M
Cardiovascular Department, S. Croce e Carle Hospital, Cuneo, Italy. agostini.m@ospedale.cuneo.it
Fino
Carlo
C
Torchio
Pierfederico
P
Di Gregorio
Vincenzo
V
Feola
Mauro
M
Bertora
Marco
M
Lugli
Elisa
E
Grossi
Claudio
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000401:mortality* / Q000601:surgery; D002423:Cause of Death; D002983:Clinical Competence / Q000706:statistics & numerical data*; D047549:Coronary Artery Bypass, Off-Pump / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000601:surgery*; D003430:Cross-Sectional Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality* / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D020521:Stroke / Q000401:mortality*