Transit Time Flow Measurement Equalizes One And Five Year Survival Of Off And On Pump Coronary Artery Bypass Graft Patients
Gabriele Di Giammarco, MD1, Teresa M. Kieser, MD,PhD2, Daniele Marinelli, MD1, Sarah M. Rose, PhD2, Uthman Aluthman, MD2, Michele Di Mauro, MD1.
1Department of Cardiac Surgery, University “G.D’Annunzio” Chieti-Pescara, Chieti, Italy, 2Department of Cardiac Sciences, LIBIN Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
OBJECTIVE: Off-pump coronary artery bypass grafting seems to be associated with a worse long term survival, lower graft patency rate and a higher rate of readmission for PCI procedures.The aim of this retrospective multicentric study was to evaluate if intraoperative transit-time flow measurement (TTFM)might improve 1-and 5-year event-free survival in patients undergoing off-pump coronary artery bypass graft(OPCABG) compared to on-pump(ONCAB).
METHODS: From April 2004 to December 2014, 1406 patients who underwent isolated CABG(1120 ONCAB vs 286 OPCAB at two university cardiac surgery departements and in whom graft flow was measured intraoperatively were selected.A non-parsimonious propensity model(AUC 0.85)was built for sample-matching 1:3.To check the balance between matched groups, standardized difference(SD) below 10% was used.Finally, 800 patients(600 ONCAB vs 200 OPCAB)were selected, being perfectly comparable(propensity score 0.32 vs 0.31, SD 7.1%).
RESULTS: There were no differences in baseline and intraoperative characteristics of the groups.Intraoperative TTFM parameters values did not show any difference between the two groups.Short term results did not show any differences. The rate of intraoperative graft revision, mortality, myocardial infarction and graft failure in ONCABG and OPCABG were 1.5% and 1%, 1.5 and 2.5 %, 1.5 and 0.5 % and 0.7% and 0% respectively. Long-term follow-up did not show any difference. The rate of mortality, myocardial infarction, graft failure and new revascularization procedure in ONCABG and OPCABG 8% and 6%, 1.5% and 0.3%, 1.5% and 1% and 1.8% and 1% respectively. Survival probability at 12 and 60 months was 94±1% and 94±2% and 82±3% and 80±6% for the ONCABG and OPCABG group respectively (log-rank:0.57)(Fig 1).
CONCLUSIONS: Our results demonstrate that the routinely use of the TTFM as tool for intraoperative graft verification can equalizes the outcome of patients submitted to CABG using off- and on-pump strategy at both short and long term follow-up.
LEGEND FIGURE 1.Survival probability at 1 and 5 years after surgery for on and off pump coronary artery bypass graft patients. (ONCABG: on-pump coronary artery bypass graft; OPCABG: off-pump coronary bypass graft)
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