Author(s): Reeves BC, Ascione R, Caputo M, Angelini GD
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Abstract OBJECTIVE: Many studies have described reduced morbidity in hospital and equivalent midterm outcomes with off-pump coronary artery bypass (OPCAB) surgery compared to conventional CABG (CABG-CPB). However, OPCAB is sometimes converted acutely to CABG-CPB. We describe the risk of acute conversion and compare patients' outcomes for acutely converted OPCAB with unconverted OPCAB and CABG-CPB. METHODS: Consecutive acute conversions, i.e. OPCAB patients in whom CPB was instituted urgently for hemodynamic or electrical instability, cardiac arrest or uncontrolled bleeding, were compared with propensity-matched unconverted OPCAB and CABG-CPB patients. Relative risks of death and complications in hospital, and subsequent survival were estimated. RESULTS: The risk of acute conversion between 1996 and 2004 was 1.1\% (27/2492): 5.1\% in the first 2 years, 2.2\% in the third year and 0.8\% subsequently. Odds ratios for death in hospital compared to unconverted OPCAB and CABG-CPB were 4.4 (95\% confidence interval (CI) 0.67-29.1) and 4.7 (95\% CI 1.03-21.1), respectively, and ranged from 0 to 4.5 for serious complications. Converted patients had an increased hazard of death for 3 years after surgery compared to unconverted OPCAB (hazard ratio 3.21, 95\% CI 1.20-8.59) and CABG-CPB patients (hazard ratio 3.23, 95\% CI 1.41-7.39). CONCLUSIONS: Experienced OPCAB surgeons have a low risk of acute conversion. Acutely converted patients have a moderately increased risk of death and serious complications in hospital. These risks are difficult to quantify precisely because conversion is rare.
This article was published in Eur J Cardiothorac Surg
and referenced in Journal of Addiction Research & Therapy