title: Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: results from the Danish On-pump Versus Off-pump Randomization Study (DOORS).
abstract: OBJECTIVE
  To determine whether graft patency after on-pump and off-pump coronary artery bypass surgery is similar when performed using the same heparinization protocol.
  
  
  METHODS
  In a randomized, controlled, multicenter trial, 900 patients more than 70 years of age received either on-pump or off-pump coronary artery bypass surgery. Heparin was given to achieve an activated clotting time of 400 seconds before arteriotomy in both groups. After the procedure, protamine sulfate was given to revert the activated clotting time to less than 120 seconds. Coronary angiography was performed 6 months after the operation and graft patency was assessed by independent blinded observers.
  
  
  RESULTS
  A total of 481 patients underwent angiography. In the off-pump group, 561 (79%) of 710 grafts were open, 65 (9%) were stenotic, and 84 (12%) were occluded. In the on-pump group, 549 (86%) of 650 grafts were open, 38 (5%) were stenotic, and 63 (9%) were occluded. The difference between the proportion of open grafts was statistically significant in favor of on-pump surgery (P=.01). The proportion of open left internal thoracic artery grafts was 95% in both groups. Perioperative use of intracoronary shunts did not increase the risk of stenosis of the coronary artery distal to the anastomosis.
  
  
  CONCLUSIONS
  Despite comparable heparinization, graft patency after off-pump surgery was inferior to that after on-pump surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Skejby Hospital, Aarhus University Hospital, Aarhus, Denmark; Institute of Regional Heath Services Research, University of Southern Denmark, Odense, Denmark. Electronic address: kim.houlind@iekf.au.dk.
authors.forename: Kim
authors.initials: K
authors.lastname: Houlind
authors.affiliation: Research Unit for General Practice, Aarhus University, Aarhus, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Fenger-Grøn
authors.affiliation: Department of Cardiothoracic Surgery, Gentofte Hospital, Gentofte, Denmark.
authors.forename: Susanne J
authors.initials: SJ
authors.lastname: Holme
authors.affiliation: Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Bo J
authors.initials: BJ
authors.lastname: Kjeldsen
authors.affiliation: Center for Cardiovascular Research, Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Susanne N
authors.initials: SN
authors.lastname: Madsen
authors.affiliation: Department of Anesthesia, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Bodil S
authors.initials: BS
authors.lastname: Rasmussen
authors.affiliation: Department of Cardiothoracic Surgery, Skejby Hospital, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Mogens H
authors.initials: MH
authors.lastname: Jepsen
authors.affiliation: Department of Cardiology, Aalborg Hospital, Aalborg, Denmark; Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Ravkilde
authors.affiliation: Department of Cardiology, Aalborg Hospital, Aalborg, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Aaroe
authors.affiliation: Department of Cardiology, Gentofte Hospital, Gentofte, Denmark.
authors.forename: Peter Riis
authors.initials: PR
authors.lastname: Hansen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Henrik Steen
authors.initials: HS
authors.lastname: Hansen
authors.affiliation: Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Poul Erik
authors.initials: PE
authors.lastname: Mortensen
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003718:Denmark; D004334:Drug Administration Schedule; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006494:Heparin Antagonists / Q000008:administration & dosage; D006801:Humans; D008297:Male; D011479:Protamines / Q000008:administration & dosage; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants; D006494:Heparin Antagonists; D011479:Protamines; D006493:Heparin