title: The off-pump technique in redo coronary artery bypass grafting reduces mortality and major morbidities: propensity score analysis of data from the Japan Cardiovascular Surgery Database†.
abstract: OBJECTIVE
  The benefits of off-pump coronary artery grafting (OPCAB) have been demonstrated. Especially in patients with a high number of comorbidities, redo coronary artery bypass grafting (CABG) remains a difficult entity of CABG, because patients are likely to have multiple risk factors and often have diseased patent grafts with adhesions. The aim of the present study was to evaluate the effects of the OPCAB technique in redo CABG on mortality and morbidity using data from the Japan Cardiovascular Surgery Database (JCVSD).
  
  
  METHODS
  We analysed 34 980 patients who underwent isolated CABG between 2008 and 2011, as reported in the JCVSD. Of these, 1.8% of patients (n = 617/34980) had undergone redo CABG, including those who underwent OPCAB (n = 364; 69%) and on-pump CABG (n = 253; 41%). We used propensity score (PS) matching with 13 preoperative risk factors to adjust for differences in baseline characteristics between the redo OPCAB and on-pump redo CABG groups. By one-to-one PS matching, we selected 200 pairs from each group.
  
  
  RESULTS
  There were no significant differences in patient background between the redo OPCAB and on-pump redo CABG groups after PS matching. There was no significant difference in the mean number of distal anastomoses after matching (2.41 ± 1.00 vs 2.21 ± 1.04, P = 0.074); nevertheless, the mean operation time was significantly shorter in the redo OPCAB than the on-pump redo CABG group (353.7 vs 441.3 min, P < 0.00010). Patients in the redo OPCAB group had a lower 30-day mortality rate (3.5 vs 7.0%, P = 0.18), a significantly lower rate of composite mortality or major morbidities (11.0 vs 21.5%, P = 0.0060), a significantly lower rate of prolonged ventilation (>24 h) (7.0 vs 15.0%, P = 0.016), a significantly shorter duration of intensive care unit (ICU) stay (ICU stay ≥ 8 days) (7.0 vs 14.5%, P = 0.023) and a significantly decreased need for blood transfusions (71.5 vs 94.0%, P < 0.00010) than patients in the on-pump redo CABG group.
  
  
  CONCLUSIONS
  The off-pump technique reduced early operative mortality and the incidences of major complications in redo CABG.
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan masad@koto.kpu-m.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Dohi
authors.affiliation: Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Doi
authors.affiliation: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Okawa
authors.affiliation: Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Motomura
authors.affiliation: Japan Cardiovascular Surgery Database Organization, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yaku
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D057216:Propensity Score; D012086:Reoperation; D012189:Retrospective Studies
keywords: Coronary artery bypass grafting; Coronary artery disease; Off-pump; Reoperation