The value of off-pump coronary artery bypass grafting in the surgery for combined valvular and coronary heart disease

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Combined valvular and coronary heart disease (n=884). Intervention: Off-pump coronary artery bypass grafting (OPCABG) vs. On-pump coronary artery bypass grafting (ONCABG). Primary outcome: Postoperative atrial fibrillation (POAF) (OR 0.63, 95% CI 0.44-0.91, p=0.014).

Haokai Qin; Pilei Si; Kun Hua; Xiubin Yang

doi:10.3389/fmed.2024.1451778

November 21, 2024Frontiers in MedicineOpen Access

The value of off-pump coronary artery bypass grafting in the surgery for combined valvular and coronary heart disease

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Key result

Off-pump CABG with valve surgery linked to ~37% lower POAF and reduced AKI versus on-pump.

OR 0.63
95% CI 0.44-0.91
P=0.014
n=884

Figures

Why the study?

The study aimed to evaluate how reducing cardiopulmonary bypass duration using the off-pump CABG technique affects short-term prognosis in patients undergoing combined valve and coronary surgery.

Does off-pump coronary artery bypass grafting (OPCABG) reduce operative mortality, POAF, stroke, AKI, and PMI compared to on-pump CABG in adult patients undergoing combined CABG and valve surgery?

Study Design

Type

Cohort (n=884)

Multicenter

No

Structured PICO

Does off-pump coronary artery bypass grafting (OPCABG) reduce operative mortality, POAF, stroke, AKI, and PMI compared to on-pump CABG in adult patients undergoing combined CABG and valve surgery?

P

Population

884 adult patients (≥18 years) undergoing combined coronary artery bypass grafting (CABG) and valve surgery for coexisting valvular and coronary artery disease, 76.2% male, at a single center in China. Excluded: emergency surgery, missed postoperative continuous ECG records, combined with aortic dissection.

I

Intervention

Off-pump coronary artery bypass grafting (OPCABG) combined with valve surgery

C

Comparator

On-pump coronary artery bypass grafting (ONCABG) combined with valve surgery

O

Outcome

Operative mortality, postoperative atrial fibrillation (POAF), stroke, acute kidney failure (AKI), and perioperative myocardial infarction (PMI) within 30 days after surgery (POAF recorded for 5 days)hard clinical

Main Result

Effect estimate: OR 0.63 (95% CI 0.44-0.91)

Absolute Event Rate: 29.5% vs 39.5%

p-value: p=0.014

In patients undergoing combined CABG and valve surgery, utilizing the off-pump CABG technique significantly reduces the short-term incidence of postoperative atrial fibrillation and acute kidney injury compared to on-pump CABG.

Limitations

Retrospective study design limits the ability to collect all unknown confounding factors, such as intraoperative variables.
Potential selection bias as OPCABG might be more likely to be performed in patients with more complicated coronary anatomy.
Only included patients who signed informed consent, which may affect the accuracy of the conclusions.
Did not evaluate the effect of the OPCABG technique on long-term prognosis.

Implication

OPCABG may be considered in combined procedures but should not yet change practice; leaves open need for randomized confirmation.

Abstract

Background Combined valve and coronary surgery is a commonly performed surgical technique for treating coexisting valvular and coronary artery disease. This study aims to investigate the effect of reducing the duration of cardiopulmonary bypass by utilizing the off-pump coronary artery bypass grafting (OPCABG) technique on the short-term prognosis of patients. Methods In this retrospective cohort study, 884 patients were divided into groups undergoing OPCABG or on-pump CABG combined with valve surgery based on the CABG technique. We evaluated the relationship between the surgical technique and operative mortality, postoperative atrial fibrillation (POAF), stroke, acute kidney failure (AKI), and perioperative myocardial infarction. Propensity score matching and inverse probability weighting (IPTW) were employed to mitigate differences in baseline characteristics between the two groups. Results The incidence of POAF and AKI were lower in the OPCABG group after IPTW (POAF: 29.5% vs. 39.5%, p = 0.016; AKI: 14.5% vs. 21.2%, p = 0.047). OPCABG technique was independently associated with the POAF (adjusted OR: 0.63, 95% CI: 0.44–0.91, p = 0.014) and AKI (adjusted OR: 0.63, 95% CI: 0.39–0.98, p = 0.049). These results remained even following PSM and IPTW analyses. Conclusion The OPCABG technique is associated with reduced occurrences of POAF and AKI in patients undergoing valve and concomitant coronary surgery and can be safely used.

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Cite This Study

Qin et al. (2024) conducted a cohort in Combined valvular and coronary heart disease (n=884). Off-pump coronary artery bypass grafting (OPCABG) vs. On-pump coronary artery bypass grafting (ONCABG) was evaluated on Postoperative atrial fibrillation (POAF) (OR 0.63, 95% CI 0.44-0.91, p=0.014). Off-pump coronary artery bypass grafting combined with valve surgery significantly reduced the incidence of postoperative atrial fibrillation (OR 0.63) and acute kidney injury compared to on-pump surgery.

synapsesocial.com/papers/6a13f1fa2ecb6dc541893579 https://doi.org/10.3389/fmed.2024.1451778