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Off-Pump Technique reduced operative mortality and the incidence of major complications in redo Coronary Artery Bypass Grafting : A Propensity Score Analysis From a Japan Cardiovascular Surgery Database (JCVSD)
Masahiro Dohi1, Kiyoshi Doi1, Hiroaki Miyata2, Noboru Motomura3, Shuhei Fujita1, Suguru Ohira1, Hidetake Kawajiri1, Tsunehisa Yamamoto1, Taiji Watanabe1, Kazunari Okawa1, Sinichi Takamoto3, Hitoshi Yaku1.
1Department of Cardiovascular & Thoracic Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan, 2Department of Healthcare Quality Assessment Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, 3Department of Cardiac Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
OBJECTIVE: The benefits of off-pump coronary artery grafting (OPCAB) have been demonstrated, especially in patients with high co-morbidity. Redo CABG is a still difficult entity of CABG, because patients are likely have multiple risk factors and often have diseased patent grafts in adhesion. The aim of the present study was to evaluate the effects of the OPCAB technique on mortality and morbidity of CABG from a Japan Cardiovascular Surgery Database (JCVSD).
METHODS: We analyzed 46,576 patients who underwent isolated CABG through JCVSD between 2005 and 2011. Of these, we identified 892 (19.2%) patients who underwent redo CABG, including those who underwent OPCAB (n = 524; 58.7%) and on-pump CABG (n = 368; 41.3%). We used propensity-score (PS) matching with 13 preoperative risk factors to adjust for differences in baseline characteristics between the OPCAB and on-pump CABG groups. By one-to-one PS matching, we selected 200 pairs of OPCAB and on-pump CABG.
RESULTS: There were no significant differences in patient background between the OPCAB and on-pump CABG groups after PS matching. The patients into OPCAB group had a lower tendency although there were no significant difference between two groups (3.5% vs 7.0%; P = .177). The OPCAB group had a significantly lower rate of composite mortality and major morbidities (11.0% vs. 21.5%; P = .006), prolonged ventilation (>24h) (7.0% vs. 15.0%; P = .016), shorter duration of intensive care unit (ICU) stay (the number of patients who stayed in the ICU for more than 8 days) (7.0% vs. 14.5% days; P = .023), and shorter mean operative time (353.7 min vs. 441.3 min; P < .0001) than the on-pump CABG group.
CONCLUSIONS: The off-pump technique reduced early operative mortality and the incidences of major complications in redo CABG.
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