title: On-pump versus off-pump coronary artery bypass surgery in patients with preoperative anemia.
abstract: OBJECTIVE
  The study objective was to evaluate the effects on early outcome and midterm survival of performing coronary artery bypass grafting with the off-pump technique in comparison with cardiopulmonary bypass (on-pump) in patients with preoperative anemia.
  
  
  METHODS
  Consecutive adult anemic patients (preoperative hemoglobin <13.0 g/dL in men and <12.0 g/dL in women) resident in Puglia region who underwent isolated coronary artery bypass grafting between January 2011 and November 2013 were considered. Vital status was ascertained from the date of surgery to December 31, 2013. Odds ratio and hazard ratio (HR) were estimated. Propensity score methods were used to control for confounders.
  
  
  RESULTS
  Of 939 anemic patients (234 female, aged 71 ± 9 years), 361 underwent operation with the off-pump technique and 578 underwent operation with the on-pump technique. Patients undergoing off-pump coronary artery bypass had a shorter intensive care unit length of stay, lower blood transfusion rate, and postoperative reduction in creatinine clearance. During a median follow-up of 18 months, 126 patients died: 46 in hospital (35 on-pump) and 80 after discharge (33 on-pump). In comparison with the off-pump technique, the on-pump technique had greater hospital mortality (odds ratio, 2.57; P = .028) and 30-day incidence of fatal events (HR, 2.67; P = .026). After a period without risk differences between groups (1-6 months; HR, 0.79; P = .618), a lower mortality in those undergoing the on-pump technique was detected (after 6 months HR, 0.35; P = .014). All results were confirmed in the 157 pairs of patients matched for propensity score, anemia grade, and surgery center.
  
  
  CONCLUSIONS
  In patients with low levels of preoperative hemoglobin, off-pump coronary artery bypass was associated with lower early morbidity and mortality but a greater risk of mortality during follow-up compared with on-pump coronary artery bypass.
authors: Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy. Electronic address: domenico.paparella@uniba.it.
authors: Domenico
authors: D
authors: Paparella
authors: Puglia Health Regional Agency, Bari, Italy.
authors: Pietro
authors: P
authors: Guida
authors: Department of Cardiac Surgery, Vito Fazzi Hospital, Lecce, Italy.
authors: Giuseppe
authors: G
authors: Scrascia
authors: Department of Cardiac Surgery, Villa Verde Hospital, Taranto, Italy.
authors: Vitantonio
authors: V
authors: Fanelli
authors: Department of Cardiac Surgery, Villa Verde Hospital, Taranto, Italy.
authors: Marco
authors: M
authors: Contini
authors: Department of Cardiac Surgery, Vito Fazzi Hospital, Lecce, Italy.
authors: Salvatore
authors: S
authors: Zaccaria
authors: Department of Cardiac Surgery, Santa Maria Hospital, Bari, Italy.
authors: Giuseppe
authors: G
authors: Labriola
authors: Department of Cardiac Surgery, Mater Dei Hospital, Bari, Italy.
authors: Carmine
authors: C
authors: Carbone
authors: Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
authors: Florinda
authors: F
authors: Mastro
authors: Department of Cardiac Surgery, Mater Dei Hospital, Bari, Italy.
authors: Valerio
authors: V
authors: Mazzei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins