title: Outcomes after conversion in the Veterans Affairs randomized on versus off bypass trial.
abstract: BACKGROUND
  The Randomized On versus Off Bypass trial reported conversion of 12.4% (n = 137) off-pump coronary artery bypass (OPCAB) patients and 3.6% (n = 40) on-pump cardiopulmonary bypass (CPB) patients. This paper explored outcomes after conversions.
  
  
  METHODS
  Elective and urgent CABG patients (n = 2,203) at 18 sites were studied. Randomization within 54 participating surgeons occurred preoperatively, after which conversion occurred if clinically indicated. Conversion reasons and outcomes were captured prospectively with additional details retrospectively extracted from patient records by a core clinical group.
  
  
  RESULTS
  Conversion rates varied considerably across participating surgeons. Converted OPCAB patients had more right coronary disease and coronary targets less than 1.5 mm. Conversions were elective in 49.3% of cases, urgent in 27.2%, or emergent in 23.5%. Elective conversions were mainly for poor exposure-intramyocardial vessel (35.8%). Urgent and emergent conversions were usually for hemodynamic instability (89.2% and 75.0%, respectively). Compared with CPB and OPCAB patients, OPCAB-converted patients had more 30-day complications and deaths (composite outcome rate of 5.7% and 5.5% vs 17.5% respectively, p < 0.001). Thirty-day outcomes for OPCAB-converted patients trended worse for emergent versus elective conversions (31.3% vs 13.4%, respectively, p = 0.05). One-year composite outcome rate (death, nonfatal myocardial infarction or revascularization) in OPCAB-converted patients was worse than in CPB patients (13.5% vs 7.1%, p = 0.02), but similar to OPCAB-nonconverted (9.4%).
  
  
  CONCLUSIONS
  The OPCAB patients requiring conversion had worse 30-day and 1-year outcomes. The OPCAB patients with right coronary artery disease or small targets were more often converted. The 30-day composite outcome trended worst for emergent OPCAB conversions.
authors: James A Haley Veterans Hospital and the University of South Florida, Tampa, Florida, USA. novitzky@aol.com
authors: Dimitri
authors: D
authors: Novitzky
authors: Janet H
authors: JH
authors: Baltz
authors: Brack
authors: B
authors: Hattler
authors: Joseph F
authors: JF
authors: Collins
authors: Elizabeth
authors: E
authors: Kozora
authors: A Laurie
authors: AL
authors: Shroyer
authors: Frederick L
authors: FL
authors: Grover
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D016037:Single-Blind Method; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014654:Vascular Patency