title: Conversion after off-pump coronary artery bypass grafting: the CORONARY trial experience.
abstract: Emergent and late conversions form OFF-to-ON pump coronary artery bypass grafting (CABG) have been associated with worse outcomes, however, it remains unclear as to which risk factors are associated with conversion and how to prevent them.
  
  
  
  Among 4718 patients who randomly underwent off- or on-pump CABG, the incidence of off-pump to on-pump cross-over, or 'OFF-to-ON conversion', was 7.9% (186/2356). The primary outcome was a composite of death, stroke, myocardial infarction, or new renal failure requiring dialysis. We assessed the risk factors and outcomes of converted patients.
  
  
  
  Emergent OFF-to-ON conversions, defined as conversions for hypotension or ischaemia, were required for 3.2% of patients ( n  = 75), while most elective conversions were due to small or intramuscular coronaries ( n  = 83). OFF-to-ON converted patients required increased surgery time, blood transfusions, intensive care unit stay, and presented a higher incidence at 1 year of the composite outcome compared with non-converted off-pump patients (all P < 0.01), especially if the conversion was emergent. Conversely, elective conversions outcomes were no different compared with non-converted off-pump patients ( P  = 0.35). Independent predictors of emergent conversions included higher heart rate or chronic atrial fibrillation, urgent surgery, more grafts planned and surgeon experience with off-pump CABG.
  
  
  
  Emergent OFF-to-ON conversion is associated with worse outcomes compared with elective conversion or no conversion. In the presence of risk factors for emergent conversion, an early and elective conversion approach is a judicious strategy.
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal and Research Center, Montreal, QC, Canada.
authors.forename: Louis-Mathieu
authors.initials: LM
authors.lastname: Stevens
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal and Research Center, Montreal, QC, Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noiseux
authors.affiliation: Research Division, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.affiliation: Department of Cardiothoracic Surgery, India Global Hospitals, Hyderabad, India.
authors.forename: Dharma Rakshak
authors.initials: DR
authors.lastname: Ayapati
authors.affiliation: Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Cardiovascular Surgery, São Francisco Hospital, Porto Alegre, Brazil.
authors.forename: Fernando Antonio
authors.initials: FA
authors.lastname: Lucchese
authors.affiliation: Department of Cardiothoracic Surgery, Institute of Cardiology of Corrientes, Corrientes, Argentina.
authors.forename: Horacio
authors.initials: H
authors.lastname: Cacheda
authors.affiliation: Department of Cardiothoracic Surgery, Mercy Medical Research Institute, St-Louis, MO, United States.
authors.forename: Sirish
authors.initials: S
authors.lastname: Parvathaneni
authors.affiliation: Department of Surgery, Division of Cardiac Surgery McMaster University and Population Health Research Institute, Hamilton, ON, Canada.
authors.forename: Yongning
authors.initials: Y
authors.lastname: Ou
authors.affiliation: Department of Surgery, Division of Cardiac Surgery McMaster University and Population Health Research Institute, Hamilton, ON, Canada.
authors.forename: André
authors.initials: A
authors.lastname: Lamy
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007431:Intraoperative Complications / Q000628:therapy; D007432:Intraoperative Period; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Cardiopulmonary bypass (CPB); Clinical trials; Coronary artery bypass grafting; Intraoperative care ; Off-pump surgery