title: On-pump and off-pump coronary artery bypass grafting in patients with left main stem disease: a propensity score analysis.
abstract: OBJECTIVE
  This study compared safety and efficacy between off-pump coronary artery bypass grafting (OPCAB), a relatively new technique, and conventional on-pump coronary artery bypass grafting (CCAB) in patients with left main stem disease.
  
  
  METHODS
  In a retrospective, observational, cohort study of prospectively collected data on 2375 consecutive patients with left main stem disease undergoing isolated CABG (1297 OPCAB, 1078 CCAB) between April 1996 and December 2009 at the Bristol Heart Institute, 548 patients undergoing OPCAB were matched with 548 patients undergoing CCAB by propensity score.
  
  
  RESULTS
  After propensity matching, groups were comparable in preoperative characteristics. Relative to CCAB, OPCAB was associated with lower in-hospital mortality (0.5% vs 2.9%; P = .001), incidence of stroke (0% vs 0.9%; P = .02), postoperative renal dysfunction (4.9% vs 10.8%; P = .001), pulmonary complications (10.2% vs 16.6%; P = .002), and infectious complications (3.5% vs 6.2%; P = .03). The OPCAB group received fewer grafts than did the CCAB group (2.7 ± 0.7 vs 3 ± 0.7; P = .001) and had a lower rate of complete revascularization (88.3% vs 92%; P = .04). In multivariable analysis, cardiopulmonary bypass was confirmed to be an independent predictor of in-hospital mortality (odds ratio, 5.74; P = .001). Survivals at 1, 5, and 10 years were similar between groups (OPCAB, 96.8%, 87.3%, and 71.7%; CCAB, 96.8%, 88.6%, and 69.8%).
  
  
  CONCLUSIONS
  OPCAB in patients with left main stem disease is a safe procedure with reduced early morbidity and mortality and similar long-term survival to conventional on-pump revascularization.
authors.affiliation: Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
authors.forename: Michele
authors.initials: M
authors.lastname: Murzi
authors.forename: Massimo
authors.initials: M
authors.lastname: Caputo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aresu
authors.forename: Simon
authors.initials: S
authors.lastname: Duggan
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome