title: Is off-pump technique a safer procedure for coronary revascularization? A propensity score analysis of 20 years of experience.
abstract: We aim to describe our experience in coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass by comparing intraoperative and postoperative outcomes.
  
  
  
  From January 1993 to June 2013, 3097 patients underwent consecutive emergency and scheduled CABG surgery. A total of 1770 patients underwent on-pump CABG (ONCABG) and 1327 off-pump CABG (OPCABG). A propensity score matching was performed to identify appropriate matched-pair patients; univariable and multivariable logistic regression analyses were performed to assess significant predictors of hospital and 30-day morbidity and mortality composite end-points. Morbidity composite end-point was defined as any renal, pulmonary, cardiovascular and neurological complication that occurred during hospital stay. We collected all-cause mortality data during the study period.
  
  
  
  We identified 1004 patients in each group. There were no significant differences in thirty day mortality, 2.8 vs 3.8%, in OPCABG and ONCABG, respectively (P = 0.21). Cardiovascular, neurological, respiratory and renal complications were more frequent in the ONCABG group: 13.9 vs 8.7% (P < 0.001), 3.9 vs 2.2% (P = 0.03), 13.5 vs 7.5% (P < 0.001), 7.1 vs 5.3% (P = 0.095), respectively. The long-term all-cause mortality rate was 12.3 vs 12.9% in the OPCABG versus ONCABG group (P = 0.42), respectively. In both uni- and multivariable analysis preoperative renal failure, chronic obstructive pulmonary disease and ONCABG were independent predictors of mortality and morbidity composite end-points.
  
  
  
  OPCABG is associated with less postoperative morbimortality and shorter hospital and intensive care unit length of stay. ONCABG resulted as an independent predictor of morbidity and mortality composite end-point. No statistically significant differences were observed in long-term all-cause mortality between groups.
authors.affiliation: Department of Cardiovascular-Anesthesia and Intensive Care, University Hospital La Fe, Valencia, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Carmona
authors.affiliation: Department of Cardiac Surgery, General Hospital of Valencia, Valencia, Spain feco_py@hotmail.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Paredes
authors.affiliation: Department of Cardiovascular-Anesthesia and Intensive Care, University General Hospital, Valencia, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Mateo
authors.affiliation: Department of Cardiac Surgery, General Hospital of Valencia, Valencia, Spain.
authors.forename: Armando V
authors.initials: AV
authors.lastname: Mena-Durán
authors.affiliation: Department of Cardiac Surgery, General Hospital of Valencia, Valencia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Hornero
authors.affiliation: Department of Cardiac Surgery, General Hospital of Valencia, Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Martínez-León
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology
keywords: Coronary artery bypass graft; Off-pump; On-pump; Outcomes; Survival