title: Off-Pump Conversion: In-hospital Mortality and Long-Term Survival.
abstract: BackgroundThere is an ongoing debate on the benefits and risks of off-pump coronary artery bypass grafting (CABG) surgery. The fate of patients who start with their procedure being an off-pump one and then have to undergo conversion to an on-pump procedure is debated with regard to in-hospital mortality and unknown with regard to long-term survival. We investigated the in-hospital mortality and long-term survival of patients who underwent conversion from off- to on-pump surgery.MethodsWe performed a multivariate and propensity analysis on in-hospital mortality and long-term survival of postisolated CABG patients in a single institution having 15,704 patients of which 5,353 who underwent off-pump CABG were analyzed.ResultsIn-hospital mortality was 2.15% for the study cohort, and 73 (1.4%) off-pump cases were converted. Univariate analysis demonstrated that patients undergoing conversion had a significantly increased in-hospital mortality (p< 0.001) and reduced long-term survival (p= 0.002). Logistic regression (receiver operating curve 0.77, Hosmer-Lemeshow test 0.46) and Cox analysis demonstrated that in-hospital mortality and long-term survival were not significantly affected by conversion. Propensity analysis (one:many match) demonstrated that in-hospital mortality was not significantly affected (p= 0.7), and long-term survival - univariate, and multivariate were also not significantly reduced in patients undergoing conversion.ConclusionConversion from off- to on-pump by a team of surgeons and anesthetists who are dedicated off-pump specialists does not have an impact on in-hospital mortality or long-term survival.
authors.affiliation: Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Pullan
authors.affiliation: Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Aung
authors.initials: A
authors.lastname: Oo
authors.affiliation: Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Poullis
mesh_terms: D000368:Aged; 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 / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome