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May 6, 2006European Journal of Cardio-Thoracic Surgery

Morbidity and mortality following acute conversion from off-pump to on-pump coronary surgery

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Why the study?

Does acute conversion from OPCAB to CABG-CPB increase mortality and morbidity compared to unconverted OPCAB or planned CABG-CPB in patients undergoing isolated CABG?

Population

6,675 consecutive patients undergoing isolated coronary artery bypass graft operations between April 1996…

Comparison

Acute conversion from off-pump coronary artery… vs Propensity-matched unconverted OPCAB patients…

Design

Cohort

Follow-up

median 2.5 to 3.2 years (maximum 8.5 years)

Authors

BRBarnaby C ReevesUniversity of LondonRARaimondo AscioneCardiac SurgeryMCMassimo CaputoCardiac Surgery

Discussion

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Implication

Acute conversion associated with higher mortality; leaves open causal contribution versus selection bias in this observational cohort.

Structured PICO

Does acute conversion from OPCAB to CABG-CPB increase mortality and morbidity compared to unconverted OPCAB or planned CABG-CPB in patients undergoing isolated CABG?

P
Population
6,675 consecutive patients undergoing isolated coronary artery bypass graft (CABG) operations between April 1996 and September 2004. Excluded: single vessel disease, emergency or salvage operations.
I
Intervention
Acute conversion from off-pump coronary artery bypass (OPCAB) to on-pump cardiopulmonary bypass (CABG-CPB) due to emergency (e.g., haemodynamic or electrical instability, cardiac arrest, haemorrhage).
C
Comparator
Propensity-matched unconverted OPCAB patients and conventional CABG-CPB patients.
O
Outcome
In-hospital mortality and morbidity, and mid-term all-cause mortality.hard clinical

Acute conversion from off-pump to on-pump CABG is associated with significantly higher mid-term mortality compared to both unconverted off-pump and planned on-pump CABG.

Limitations

  • Small number of acute conversions (n=27) limited the number of variables for propensity score estimation
  • Low power for tests of proportionality due to small number of deaths

Cite This Study

Reeves et al. (2006) studied this question.

synapsesocial.com/papers/6a707f40febe604dd7094744https://doi.org/10.1016/j.ejcts.2006.03.018
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Also Consider

Synapse has enriched 2 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Routine Intracoronary Shunting in Multivessel Off-Pump Coronary Artery Bypass: A Retrospective Review of in-Hospital Outcomes in 550 Consecutive Cases2005 · 3 citations
  2. 2Aborted Off-Pump Coronary Artery Bypass Patients Have Much Worse Outcomes Than On-Pump or Successful Off-Pump Patients2005 · 85 citations