title: Emergency coronary artery bypass grafting using minimized versus standard extracorporeal circulation--a propensity score analysis.
abstract: BACKGROUND
  The impact of minimized extracorporeal circulation (MECC) for emergency revascularization remains controversial.
  
  
  METHODS
  A total of 348 patients underwent emergency CABG with MECC (n=146) or conventional extracorporeal circulation (CECC; n=175) between January 2005 and December 2010. Using propensity score matching after binary logistic regression, 100 patients, who underwent CABG with MECC could be matched with 100 patients, who underwent CABG with CECC. Primary outcome was 30-day mortality.
  
  
  RESULTS
  Unadjusted 30-day mortality was 14.8% in patients with CECC and 6.9% in those with MECC (mean difference -7.9%; p=0.03). The adjusted mean difference (average treatment effect of the treated, ATT) after matching was -1.0% (95% CI -8.6 to 7.6; p=1.0). Intensive care unit stay (adjusted mean difference 1.0; 95% CI -0.2 to 3.2; p=0.70) and hospital stay (adjusted mean difference 1.0; 95% CI -2.0 to 3.6; p=0.40) did not show significant differences between both groups. The adjusted mean difference for postoperative low cardiac output syndrome was -1.1% (95% CI -7.3 to 7.1; p=0.83) without significant differences between CECC and MECC. Postoperative mechanical ventilation time, drain loss, postoperative rethoracotomy, postoperative neurological events, new onset renal replacement therapy and respiratory failure also had insignificant average treatment effects of the treated. In addition, all average treatment effects (ATEs) did not significantly differ between both groups.
  
  
  CONCLUSIONS
  Using propensity score estimation and matching, we did not observe significant differences in terms of survival and further outcomes in patients who undergo emergency CABG with CECC or MECC, but our results call for further analysis.
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany. micha.ried@t-online.de
authors.forename: Michael
authors.initials: M
authors.lastname: Ried
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
authors.forename: Philipp
authors.initials: P
authors.lastname: Kolat
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kobuch
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Claudius
authors.initials: C
authors.lastname: Diez
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D004635:Emergency Medicine; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
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