title: Meta-analysis of organ damage after conversion from off-pump coronary artery bypass procedures.
abstract: The relative efficacy of off-pump and on-pump coronary revascularization is uncertain. A complication of off-pump surgery which is rarely considered is intraoperative conversion to cardiopulmonary bypass. Consequently, meta-analysis was performed of studies comparing morbidity after converted and nonconverted off-pump coronary revascularization. There were significant increases in the likelihood of stroke, myocardial injury, bleeding, renal failure, wound infection, intraaortic balloon pump requirement, transfusion, and respiratory and gastrointestinal complications after conversion. The underlying mechanisms need to be urgently elucidated. Prevention and treatment protocols for conversion warrant serious consideration and the risk of conversion may need to be discussed when obtaining informed patient consent.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, London, United Kingdom.
authors.forename: Dayal
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Christopher
authors.initials: C
authors.lastname: Rao
authors.forename: Michael
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.forename: Aristotle
authors.initials: A
authors.lastname: Protopapas
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D041981:Gastrointestinal Tract / Q000098:blood supply; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007511:Ischemia / Q000209:etiology; D009203:Myocardial Infarction / Q000097:blood; D017202:Myocardial Ischemia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D011654:Pulmonary Edema / Q000209:etiology; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology