Acute 30-day Outcomes Related To Surgeons’ Experience In Off Pump Coronary Artery Bypass Grafting
Yvonne Schneeberger1, Andreas Schaefer1, Jeannette Schoenebeck1, Gerhard Schoen2, Matz Bernhard1, Philipp Geronne1, Beate Reiter1, Hermann Reichenspurner1.
1University Heart Center Hamburg, Hamburg, Germany, 2University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
OBJECTIVE: Off-pump coronary artery bypass grafting (OPCAB) is an established therapy for coronary artery disease in the elderly with or without severely calcified aorta. Compared to on-pump technique, OPCAB is considered to be more technically demanding. To date, no reports exist documenting acute outcomes of OPCAB related to different stages of surgeons‘ experience.
METHODS: From 2010 till 2015, 1049 consecutive patients (77.7 % male, 69.9 ± 9.8 years, logEuroSCORE II 2.9 ± 3.6%) received OPCAB at our center. Surgeons’ experience was retrospectively evaluated as follows: beginner (< 50 OPCAB procedures); trained (≥ 50 OPCAB procedures); skilled (performing OPCAB on a daily basis). Acute 30-day outcomes were retrospectively analyzed and correlated to experience levels.
RESULTS: Overall 30-day mortality was 1.7% (18/1432 pts.) 30-day mortality presented no significant differences related to surgeons‘ experience. Beginner surgeons presented OR of 1.7 (CI: 0.8-3.4; p=0.13) compared to skilled surgeons for 30-day mortality. Trained surgeons showed OR of 1.9 (CI: 0.9-3.8; p=0.07) compared to skilled surgeons. While skilled surgeons led to no change in mortality in patients with increasing age, trained and beginner surgeons presented impaired outcomes in the elderly patient population (see Figure 1).
CONCLUSIONS: OPCAB procedures can be performed safely by beginner and trained surgeons under supervision with comparable acute outcomes compared to skilled surgeons. Patient and surgeon selection especially with regard to patient age is of crucial importance to further improve outcomes.
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