Outcomes of On-Pump versus Off-Pump Coronary Artery Bypass Graft Surgery in the High Risk (AusSCORE > 5)

Vikrant Dhurandhar; Akshat Saxena; Roneil Parikh; Michael P Vallely; Michael K Wilson; Jennifer Kay Butcher; Deborah Ann Black; Lavinia Tran; Christopher M Reid; Paul G Bannon

doi:10.1016/j.hlc.2015.02.009

Outcomes of On-Pump versus Off-Pump Coronary Artery Bypass Graft Surgery in the High Risk (AusSCORE > 5)

Heart Lung Circ. 2015 Dec;24(12):1216-24. doi: 10.1016/j.hlc.2015.02.009. Epub 2015 Feb 23.

Authors

Affiliations

¹ Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia. Electronic address: vikrantdhurandhar@hotmail.com.
² Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia.
³ Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia.
⁴ Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
⁵ Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
⁶ CCRE Therapeutics, DEPM, Monash University, Melbourne, Vic., Australia.

PMID: 25778621
DOI: 10.1016/j.hlc.2015.02.009

Abstract

Background: Coronary artery bypass graft surgery (CABG) has been established as the preferred intervention for coronary revascularisation in the high-risk population. Off-pump coronary artery bypass (OPCAB) may further reduce mortality and morbidity in this population subgroup. This study presents the largest series of high-risk (AusSCORE > 5) OPCAB patients in Australia and New Zealand.

Methods: We reviewed the Australian and New Zealand Society of Cardiac and Thoracic Surgeons' (ANZSCTS) database for high-risk patients (n=7822) undergoing isolated CABG surgery and compared the on-pump coronary artery bypass (ONCAB) (n=7277) with the OPCAB (n=545) technique. Preoperative and intraoperative risk factors, and postoperative outcomes were analysed. Survival analysis was performed after cross-matching the database with the national death registry to identify long-term mortality.

Results: The ONCAB and OPCAB groups had similar risk profiles based on the AusSCORE. Thirty-day mortality (ONCAB vs OPCAB 3.9% vs 2.4%, p=0.067) and stroke (ONCAB vs OPCAB 2.4% vs 1.3%, p=0.104) were similar between the two groups. OPCAB patients received fewer distal anastomoses than ONCAB patients (2.5±1.2 vs 3.3±1.0, p<0.001). The rates of new postoperative atrial arrhythmia (28.3% vs 33.3%, p=0.017) and blood transfusion requirements (52.1% vs 59.5%, p=0.001) were lower in the OPCAB group, while duration of ICU stay in hours (97.4±187.8 vs 70.2±152.8, p<0.001) was longer. There was a non-significant trend towards improved 10-year survival in OPCAB patients (74.7% vs. 71.7%, p=0.133).

Conclusions: In the high-risk population, CABG surgery has a low rate of mortality and morbidity suggesting that surgery is a safe option for coronary revascularisation. OPCAB reduces postoperative morbidity and is a safe procedure for 30-day mortality, stroke and long-term survival in high-risk patients.

Keywords: CABG; Coronary artery bypass graft; Elderly; High risk; Off-pump; On-pump.

Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Publication types

Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Arrhythmias, Cardiac* / etiology
Arrhythmias, Cardiac* / mortality
Arrhythmias, Cardiac* / therapy
Australia / epidemiology
Blood Transfusion*
Coronary Artery Bypass, Off-Pump* / adverse effects
Coronary Artery Bypass, Off-Pump* / methods
Databases, Factual*
Disease-Free Survival
Female
Humans
Male
New Zealand / epidemiology
Postoperative Complications* / etiology
Postoperative Complications* / mortality
Postoperative Complications* / therapy
Risk Factors
Stroke* / etiology
Stroke* / mortality
Stroke* / therapy
Survival Rate