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Xu F, Li L, Zhou C, Wang S, Ao H. On-Pump or Off-Pump Impact of Diabetic Patient Undergoing Coronary Artery Bypass Grafting 5-Year Clinical Outcomes. Rev Cardiovasc Med 2024; 25:349. [PMID: 39355604 PMCID: PMC11440410 DOI: 10.31083/j.rcm2509349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 10/03/2024] Open
Abstract
Background For diabetic patients undergoing coronary artery bypass grafting (CABG), there is still a debate about whether an off-pump or on-pump approach is advantageous. Methods A retrospective review of 1269 consecutive diabetic patients undergoing isolated, primary CABG surgery from January 1, 2013 to December 31, 2015 was conducted. Among them, 614 received non-cardiopulmonary bypass treatment during their operation (off-pump group), and 655 received cardiopulmonary bypass treatment (on-pump group). The hospitalization outcomes were compared by multiple logistic regression models with patient characteristics and operative variables as independent variables. Kaplan-Meier curves and Cox proportional-hazard regression models for mid-term (2-year) and long-term (5-year) clinical survival analyses were used to determine the effect on survival after CABG surgery. In order to further verify the reliability of the results, propensity-score matching (PSM) was also performed between the two groups. Results Five-year all-cause death rates were 4.23% off-pump vs. 5.95% on-pump (p = 0.044), and off-pump was associated with reduced postoperative stroke and atrial fibrillation. Conclusions These findings suggest that off-pump procedures may have benefits for diabetic patients in CABG.
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Affiliation(s)
- Fei Xu
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Lei Li
- Department of Cardiovascular Surgery, Affiliated Hospital of Weifang Medical University, 261071 Weifang, Shandong, China
| | - Chenghui Zhou
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Sheng Wang
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Hushan Ao
- Department of Anesthesiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, 100037 Beijing, China
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Wagner TH, Hattler B, Stock EM, Biswas K, Bhatt DL, Bakaeen FG, Gujral K, Zenati MA. Costs of Endoscopic vs Open Vein Harvesting for Coronary Artery Bypass Grafting: A Secondary Analysis of the REGROUP Trial. JAMA Netw Open 2022; 5:e2217686. [PMID: 35727582 PMCID: PMC9214587 DOI: 10.1001/jamanetworkopen.2022.17686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Value-based purchasing creates pressure to examine whether newer technologies and care processes, including new surgical techniques, yield any economic advantage. OBJECTIVE To compare health care costs and utilization between participants randomized to receive endoscopic vein harvesting (EVH) or open vein harvesting (OVH) during a coronary artery bypass grafting (CABG) procedure. DESIGN, SETTING, AND PARTICIPANTS This secondary economic analysis was conducted alongside the 16-site Randomized Endo-Vein Graft Prospective (REGROUP) clinical trial funded by the Department of Veterans Affairs (VA) Cooperative Studies Program. Adults scheduled for urgent or elective bypass involving a vein graft were eligible. The first participant was enrolled in September 2013, with most sites completing enrollment by March 2014. The last participant was enrolled in April 2017. A total of 1150 participants were randomized, with 574 participants receiving OVH and 576 receiving EVH. For this secondary analysis, cost and utilization data were extracted through September 30, 2020. Participants were linked to administrative data in the VA Corporate Data Warehouse and activity-based cost data starting with the index procedure. INTERVENTIONS EVH vs OVH, with comparisons based on intention to treat. MAIN OUTCOMES AND MEASURES Discharge costs for the index procedure as well as follow-up costs (including intended and unintended events; mean [SD] follow-up time, 33.0 [19.9] months) were analyzed, with results from different statistical models compared to test for robustness (ie, lack of variation across models). All costs represented care provided or paid by the VA, standardized to 2020 US dollars. RESULTS Among 1150 participants, the mean (SD) age was 66.4 (6.9) years; most participants (1144 [99.5%] were male. With regard to race and ethnicity, 6 participants (0.5%) self-reported as American Indian or Alaska Native, 10 (0.9%) as Asian or Pacific Islander, 91 (7.9%) as Black, 62 (5.4%) as Hispanic, 974 (84.7%) as non-Hispanic White, and 6 (0.5%) as other race and/or ethnicity; data were missing for 1 participant (0.1%). The unadjusted mean (SD) costs for the index CABG procedure were $76 607 ($43 883) among patients who received EVH and $75 368 ($45 900) among those who received OVH, including facility costs, insurance costs, and physician-related costs (commonly referred to as provider costs in Centers for Medicare and Medicaid and insurance data). No significant differences were found in follow-up costs; per 90-day follow-up period, EVH was associated with a mean (SE) added cost of $302 ($225) per patient. The results were highly robust to the statistical model. CONCLUSIONS AND RELEVANCE In this study, EVH was not associated with a reduction in costs for the index CABG procedure or follow-up care. Therefore, the choice to provide EVH may be based on surgeon and patient preferences. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01850082.
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Affiliation(s)
- Todd H. Wagner
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Department of Surgery, Stanford University, Stanford, California
| | - Brack Hattler
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
- Division of Cardiology, University of Colorado, Denver
| | - Eileen M. Stock
- Office of Research and Development, VA Cooperative Studies Program Coordinating Center, Perry Point, Maryland
| | - Kousick Biswas
- Office of Research and Development, VA Cooperative Studies Program Coordinating Center, Perry Point, Maryland
| | - Deepak L. Bhatt
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Faisal G. Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kritee Gujral
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Marco A. Zenati
- Division of Cardiac Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts
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Quin JA, Wagner TH, Hattler B, Carr BM, Collins J, Almassi GH, Grover FL, Shroyer AL. Ten-Year Outcomes of Off-Pump vs On-Pump Coronary Artery Bypass Grafting in the Department of Veterans Affairs: A Randomized Clinical Trial. JAMA Surg 2022; 157:303-310. [PMID: 35171210 PMCID: PMC8851363 DOI: 10.1001/jamasurg.2021.7578] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE The long-term benefits of off-pump ("beating heart") vs on-pump coronary artery bypass grafting (CABG) remain controversial. OBJECTIVE To evaluate the 10-year outcomes and costs of off-pump vs on-pump CABG in the Department of Veterans Affairs (VA) Randomized On/Off Bypass (ROOBY) trial. DESIGN, SETTING, AND PARTICIPANTS From February 27, 2002, to May 7, 2007, 2203 veterans in the ROOBY trial were randomly assigned to off-pump or on-pump CABG procedures at 18 participating VA medical centers. Per protocol, the veterans were observed for 10 years; the 10-year, post-CABG clinical outcomes and costs were assessed via centralized abstraction of electronic medical records combined with merges to VA and non-VA databases. With the use of an intention-to-treat approach, analyses were performed from May 7, 2017, to December 9, 2021. INTERVENTIONS On-pump and off-pump CABG procedures. MAIN OUTCOMES AND MEASURES The 10-year coprimary end points included all-cause death and a composite end point identifying patients who had died or had undergone subsequent revascularization (ie, percutaneous coronary intervention [PCI] or repeated CABG); these 2 end points were measured dichotomously and as time-to-event variables (ie, time to death and time to composite end points). Secondary 10-year end points included PCIs, repeated CABG procedures, changes in cardiac symptoms, and 2018-adjusted VA estimated costs. Changes from baseline to 10 years in post-CABG, clinically relevant cardiac symptoms were evaluated for New York Heart Association functional class, Canadian Cardiovascular Society angina class, and atrial fibrillation. Outcome differences were adjudicated by an end points committee. Given that pre-CABG risks were balanced, the protocol-driven primary and secondary hypotheses directly compared 10-year treatment-related effects. RESULTS A total of 1104 patients (1097 men [99.4%]; mean [SD] age, 63.0 [8.5] years) were enrolled in the off-pump group, and 1099 patients (1092 men [99.5%]; mean [SD] age, 62.5 [8.5] years) were enrolled in the on-pump group. The 10-year death rates were 34.2% (n = 378) for the off-pump group and 31.1% (n = 342) for the on-pump group (relative risk, 1.05; 95% CI, 0.99-1.11; P = .12). The median time to composite end point for the off-pump group (4.6 years; IQR, 1.4-7.5 years) was approximately 4.3 months shorter than that for the on-pump group (5.0 years; IQR, 1.8-7.9 years; P = .03). No significant 10-year treatment-related differences were documented for any other primary or secondary end points. After the removal of conversions, sensitivity analyses reconfirmed these findings. CONCLUSIONS AND RELEVANCE No off-pump CABG advantages were found for 10-year death or revascularization end points; the time to composite end point was lower in the off-pump group than in the on-pump group. For veterans, in the absence of on-pump contraindications, a case cannot be made for supplanting the traditional on-pump CABG technique with an off-pump approach. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01924442.
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Affiliation(s)
- Jacquelyn A. Quin
- Department of Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
| | - Todd H. Wagner
- Research Office, Veterans Affairs Health Economics and Research Center, Palo Alto, California,Department of Surgery, Stanford University, Palo Alto, California
| | - Brack Hattler
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado,Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Brendan M. Carr
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph Collins
- Research Office, Veterans Affairs Cooperative Studies Program, Perry Point, Maryland
| | - G. Hossein Almassi
- Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin,Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Frederick L. Grover
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora,Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - A. Laurie Shroyer
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York,Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
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Burnaska DR, Huang GD, O'Leary TJ. Clinical trials proposed for the VA Cooperative Studies Program: Success rates and factors impacting approval. Contemp Clin Trials Commun 2021; 23:100811. [PMID: 34307958 PMCID: PMC8287148 DOI: 10.1016/j.conctc.2021.100811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 04/26/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022] Open
Abstract
The process by which funding organizations select among the myriad number of proposals they receive is a matter of significant concern for researchers and the public alike. Despite an extensive literature on the topic of peer review and publications on criteria by which clinical investigations are reviewed, publications analyzing peer review and other processes leading to government funding decisions on large multi-site clinical trials proposals are sparse. To partially address this gap, we reviewed the outcomes of scientific and programmatic evaluation for all letters of intent (LOIs) received by the Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) between July 4, 2008, and November 28, 2016. If accepted, these LOIs represented initial steps towards later full proposals that also underwent scientific peer review. Twenty-two of 87 LOIs were ultimately funded and executed as CSP projects, for an overall success rate of 25%. Most proposals which received a negative decision did so prior to submission of a full proposal. Common reasons for negative scientific review of LOIs included investigator inexperience, perceived lack of major scientific impact, lack of preliminary data and flawed or confused experimental design, while the most common reasons for negative reviews of final proposals included questions of scientific impact and issues of study design, including outcome measures, randomization, and stratification. Completed projects have been published in high impact clinical journals. Findings highlight several factors leading to successfully obtaining funding support for clinical trials. While our analysis is restricted to trials proposed for CSP, the similarities in review processes with those employed by the National Institutes of Health and the Patient Centered Outcomes Research Institute suggest the possibility that they may also be important in a broader context.
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Affiliation(s)
- David R. Burnaska
- Cooperative Studies Program, Office of Research and Development, Veterans Health Administration, Washington DC, 20420, USA
| | - Grant D. Huang
- Cooperative Studies Program, Office of Research and Development, Veterans Health Administration, Washington DC, 20420, USA
| | - Timothy J. O'Leary
- Cooperative Studies Program, Office of Research and Development, Veterans Health Administration, Washington DC, 20420, USA
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
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Almassi GH, Hawkins RB, Bishawi M, Shroyer AL, Hattler B, Quin JA, Collins JF, Bakaeen FG, Ebrahimi R, Grover FL, Wagner TH. New-onset postoperative atrial fibrillation impact on 5-year clinical outcomes and costs. J Thorac Cardiovasc Surg 2019; 161:1803-1810.e3. [PMID: 31866082 DOI: 10.1016/j.jtcvs.2019.10.150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/27/2019] [Accepted: 10/13/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The impact of new-onset postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) surgery on long-term clinical outcomes and costs is not known. This subanalysis of the Veterans Affairs "Randomized On/Off Bypass Follow-up Study" compared 5-year outcomes and costs between patients with and without POAF. METHODS Of the 2203 veterans in the study, 100 with pre-CABG atrial fibrillation (93) or missing data (7) were excluded (4.8%). Unadjusted and risk-adjusted outcomes were compared between new-onset POAF (n = 551) and patients without POAF (n = 1552). Five-year clinical outcomes included mortality, major adverse cardiovascular events (MACE, comprising mortality, repeat revascularization, and myocardial infarction), MACE subcomponents, stroke, and costs. A stringent P value of ≤.01 was required to identify statistical significance. RESULTS Patients with POAF were older and had more complex comorbidities. Unadjusted 5-year all-cause mortality was 16.3% POAF versus 11.9% no-POAF, P = .008. Unadjusted cardiac-mortality was 7.4% versus 4.8%, P = .022. There were no differences between groups in any other unadjusted outcomes including MACE or stroke. After risk adjustment, there were no significant differences between groups in 5-year all-cause mortality (POAF odds ratio, 1.19; 99% confidence interval, 0.81-1.75) or cardiac mortality (odds ratio, 1.51, 99% confidence interval, 0.88-2.60). Adjusted first-year post-CABG costs were $15,300 greater for patients with POAF, but 2- through 5-year costs were similar. CONCLUSIONS No 5-year risk-adjusted outcome differences were found between patients with and without POAF after CABG. Although first-year costs were greater in patients with POAF, this difference did not persist in subsequent years.
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Affiliation(s)
- G Hossein Almassi
- Cardiothoracic Surgery, Zablocki Veterans Affairs Medical Center, Milwaukee, Wis; Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis.
| | - Robert B Hawkins
- Department of Surgery, Salem Veterans Affairs Medical Center, Salem, Va; Department of Surgery, University of Virginia, Charlottesville, Va
| | - Muath Bishawi
- Research Office, Northport Veterans Affairs Medical Center, Northport, NY; Department of Surgery, Duke University Medical Center, Durham, NC
| | - A Laurie Shroyer
- Research Office, Northport Veterans Affairs Medical Center, Northport, NY; Research Office, Departments of Surgery and Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colo
| | - Brack Hattler
- Research Office, Departments of Surgery and Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colo; Departments of Surgery and Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colo
| | - Jacquelyn A Quin
- Department of Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Mass; Harvard Medical School, Boston, Mass
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Perry Point Veterans Affairs Medical Center, Perry Point, Md
| | - Faisal G Bakaeen
- Department of Surgery, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, Pa; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ramin Ebrahimi
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, Calif; Department of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Frederick L Grover
- Research Office, Departments of Surgery and Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colo; Departments of Surgery and Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colo
| | - Todd H Wagner
- Health Economics Resource Center, Palo Alto Veterans Affairs Medical Center, Menlo Park, Calif; Department of Surgery, Stanford University, Stanford, Calif
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Kawabori M, Kurihara C, Critsinelis A, Chou BPH, Zhang Q, Kaku Y, Civitello AB, Morgan JA. Effect of cardiac arrest with aortic cross-clamping during left ventricular assist device implantation. Interact Cardiovasc Thorac Surg 2019; 30:47-53. [DOI: 10.1093/icvts/ivz223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/02/2019] [Accepted: 08/16/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Some patients who undergo continuous-flow left ventricular assist device (CF-LVAD) implantation require concomitant procedures that can be performed with or without cardiac arrest under aortic cross-clamping (AXC). Procedures normally performed with cardiac arrest are sometimes avoided or performed without cardiac arrest because it may be detrimental to right heart function. However, the effects of cardiac arrest on patients with advanced heart failure necessitating CF-LVAD support have not been thoroughly studied. We examined our single-centre experience to determine whether cardiac arrest during CF-LVAD implantation was associated with worse patient outcomes.
METHODS
From November 2003 to March 2016, a total of 526 patients with chronic end-stage heart failure underwent primary CF-LVAD implantation. Preoperative demographics, postoperative complications and mortality rates were compared between patients who required cardiac arrest with AXC (n = 50) and those who did not (n = 476).
RESULTS
The most frequently performed procedure requiring AXC was aortic valve closure (n = 23, 26.1%). Although the AXC group had longer cardiopulmonary bypass times (P < 0.01), long-term (5-year) survival was similar in AXC and non-AXC patients (P = 0.13). Also, postoperative right heart failure (P = 0.15) and neurological dysfunction (P = 0.89) rates were not significantly different between the 2 groups. Cox proportional hazards analysis showed that cardiac arrest with AXC was not an independent predictor of mortality (hazard ratio, 0.89; P = 0.73).
CONCLUSIONS
Cardiac arrest with AXC during CF-LVAD implantation did not negatively affect long-term survival or the incidence of right ventricular failure or stroke. These findings should be considered in deciding surgical strategies. Additional investigation may be warranted to further understand the effects of cardiac arrest during LVAD implantation.
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Affiliation(s)
- Masashi Kawabori
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, TX, USA
| | - Chitaru Kurihara
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, TX, USA
- Department of Cardiothoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Andre Critsinelis
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, TX, USA
| | - Brendan Pen-Haw Chou
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, TX, USA
| | - Qianzi Zhang
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Yuji Kaku
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, TX, USA
| | - Andrew B Civitello
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, Houston, TX, USA
| | - Jeffrey A Morgan
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Patel V, Unai S, Gaudino M, Bakaeen F. Current Readings on Outcomes After Off-Pump Coronary Artery Bypass Grafting. Semin Thorac Cardiovasc Surg 2019; 31:726-733. [PMID: 31125606 DOI: 10.1053/j.semtcvs.2019.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022]
Abstract
Off-pump coronary artery bypass grafting (CABG) gained popularity in the 1990s through early 2000s as surgeons sought to mitigate the purported adverse effects of cardiopulmonary bypass and reduce the risk of neurologic events from aortic manipulation. Since then, results of several large randomized controlled trials and meta-analyses have failed to demonstrate an advantage of off-pump CABG over traditional on-pump CABG and have even raised concerns about potential suboptimal outcomes. The modern debate about off- vs on-pump CABG centers around long-term outcomes, the role of surgeon experience, identification of specific patient populations for which off-pump CABG is most appropriate, and identification of novel techniques and technologies to improve long-term outcomes. We review the key findings of 5 contemporary papers that address these issues and provide a current perspective on the status of off-pump CABG.
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Affiliation(s)
- Viral Patel
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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