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The outcome of patients requiring emergency conversion from off-pump to on-pump coronary artery bypass grafting

Published online by Cambridge University Press:  01 April 2007

G. Landoni ,
F. Pappalardo ,
G. Crescenzi ,
G. Aletti ,
C. Marchetti ,
D. Poli ,
A. Franco ,
C. Rosica  and
A. Zangrillo
G. Landoni
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Milan, Italy
F. Pappalardo
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Milan, Italy
G. Crescenzi
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Milan, Italy
G. Aletti
Affiliation:
University of Milan, Department of Mathematics, Milan, Italy
C. Marchetti
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Milan, Italy
D. Poli
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Milan, Italy
A. Franco
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Milan, Italy
C. Rosica
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Milan, Italy
A. Zangrillo
Affiliation:
Università Vita-Salute San Raffaele, Italia e Istituto Scientifico San Raffaele, Milan, Italy
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Summary

Background and objective

Patients undergoing off-pump coronary artery bypass grafting (CABG) may need emergent institution of cardiopulmonary bypass (CPB) for circulatory collapse during the operation. Our aim was to evaluate outcome in such patients and identify preoperative and intraoperative risk factors.

Methods

This is an observational study in a University Hospital setting. In the period June 2001–July 2003, data from 988 consecutive patients undergoing CABG in our institution were prospectively collected. No interventions were made. Prolonged hospital stay (>7 days), hospital mortality, temporal trends and risk factors for conversion from off-pump to on-pump surgery were studied.

Results

Fifty-four patients with emergency operations and six with associated carotid artery surgery were excluded. Of the remaining 928 patients, 450 (48.5%) were planned for off-pump surgery. Thirty-seven (8.2%) of them required conversion to CPB on an emergency basis. These patients had higher mortality (5.4%) than the off-pump group (1.5%) and the CPB group (0.4%), P = 0.02. The incidence of prolonged hospital stay was also higher (conversion group = 27%, off-pump group = 12.3%, CPB group = 17.6%; P = 0.02). We did not identify any perioperative characteristics significantly associated with the risk of requiring conversion. The conversion rate was uniformly distributed over the study period.

Conclusions

Patients who are emergently converted to CPB during attempted off-pump procedures are at higher risk of death and prolonged hospital stay; this population should be included in comparative studies as ‘intention to treat’ in the off-pump group.

Keywords

CARDIAC SURGERYCORONARY ARTERY BYPASS, off-pumpMORTALITYTREATMENT OUTCOMECARDIOPULMONARY BYPASSANAESTHESIA, cardiothoracic
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 4 , April 2007 , pp. 317 - 322
Copyright
Copyright © European Society of Anaesthesiology 2006

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References

1.Wijeysundera, DN, Beattie, WS, Djaiani, G et al. . Off-pump coronary artery surgery for reducing mortality and morbidity: meta-analysis of randomized and observational studies. J Am Coll Cardiol 2005; 46: 872–882.CrossRefGoogle ScholarPubMed
2.Cheng, DC, Bainbridge, D, Martin, JE, Novick, RJ. Does off-pump coronary artery bypass reduce mortality, morbidity and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomised trials. Anesthesiology 2005; 102: 188–203.CrossRefGoogle Scholar
3.Parolari, A, Alamanni, F, Cannata, A et al. . Off-pump vs. on-pump coronary artery bypass: metaanalysis of currently available randomized trials. Ann Thorac Surg 2003; 76: 37–40.CrossRefGoogle Scholar
4.Schwann, NM, Horrow, JC, Strong, MD, Chamchad, D, Guerraty, A, Wechsler, AS. Does off-pump coronary artery bypass reduce the incidence of clinically evident renal dysfunction after multivessel myocardial revascularization? Anesth Analg 2004; 99: 959–964.CrossRefGoogle ScholarPubMed
5.Gamoso, MG, Phillips-Bute, B, Landolfo, KP, Newman, MF, Stafford-Smith, M. Off-pump vs. on-pump coronary artery bypass surgery and postoperative renal dysfunction. Anesth Analg 2000; 91: 1080–1084.Google Scholar
6.Zangrillo, A, Annalisa, F, Crescenzi, C et al. . Underreporting of conversion from off-pump coronary artery bypass surgery. Anesthesiology 2005; 103: 902.CrossRefGoogle ScholarPubMed
7.Legare, JF, Buth, KJ, Hirsch, GM. Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial. Eur J Cardiothorac Surg 2005; 27: 296–301.CrossRefGoogle Scholar
8.Patel, NC, Patel, NU, Loulmet, DF, McCabe, JC, Subramanian, VA. Emergency conversion to cardiopulmonary bypass during attempted off-pump revascularization results in increased morbidity and mortality. J Thorac Cardiovasc Surg 2004; 128: 655–661.CrossRefGoogle ScholarPubMed
9.Norris, JQ, Howells, S, Browne, J et al. . Failed off-pump CABG predictors and outcomes. Can J Anesth 2003; 50: A74.Google Scholar
10.Edgerton, JR, Dewey, TM, Magee, MJ et al. . Conversion in off-pump coronary artery bypass grafting: an analysis of predictors and outcomes. Ann Thorac Surg 2003; 76: 1138–1143.CrossRefGoogle ScholarPubMed
11.Iaco, AL, Contini, M, Teodori, G et al. . Off or on bypass: what is the safety threshold? Ann Thorac Surg 1999; 68: 1486–1489.CrossRefGoogle ScholarPubMed
12.Soltoski, P, Salerno, T, Levinsky, L et al. . Conversion to cardiopulmonary bypass in off-pump coronary artery bypass grafting: its effect on outcome. J Card Surg 1998; 13: 328–334.CrossRefGoogle Scholar
13.Mishra, M, Shrivastava, S, Dhar, A et al. . A prospective evaluation of hemodynamic instability during off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth 2003; 17: 452–458.CrossRefGoogle ScholarPubMed
14.Jin, R, Hiratzka, LF, Grunkemeier, GL, Krause, A, IIIPage, US. Aborted off-pump coronary artery bypass patients have much worse outcomes than on-pump or successful off-pump patients. Circulation 2005; 112 (Suppl 9): 1332–1337.CrossRefGoogle ScholarPubMed
15.Wehlin, L, Vedin, J, Vaage, J, Lundahl, J. Activation of complement and leukocyte receptors during on and off pump coronary artery bypass surgery. Eur J Cardiothorac Surg 2004; 25: 35–42.CrossRefGoogle ScholarPubMed
16.Dorman, BH, Kratz, JM, Multani, MM et al. . A prospective, randomized study of endothelin and postoperative recovery in off-pump vs. conventional coronary artery bypass surgery. J Cardiothorac Vasc Anesth 2004; 18: 25–29.CrossRefGoogle Scholar
17.Wandschneider, W, Thalmann, M, Trampitsch, E, Ziervogel, G, Kobinia, G. Off-pump coronary bypass operations significantly reduce S100 release: an indicator for less cerebral damage? Ann Thorac Surg 2000; 70: 1577–1579.CrossRefGoogle ScholarPubMed
18.Lönn, U, Peterzen, B, Carnstam, B, Casimir-Ahn, H. Beating heart coronary surgery supported by an axial blood flow pump. Ann Thorac Surg 1999; 67: 99–104.CrossRefGoogle ScholarPubMed
19.Carrier, M, Perrault, LP, Jeanmart, H, Martineau, R, Cartier, R, Page, P. Randomized trial comparing off-pump to on-pump coronary artery bypass grafting in high-risk patients. Heart Surg Forum 2003; 6: E89–E92.Google ScholarPubMed
20.Czerny, M, Baumer, H, Kilo, J et al. . Inflammatory response and myocardial injury following coronary artery bypass grafting with or without cardiopulmonary bypass. Eur J Cardiothorac Surg 2000; 17: 737–742.CrossRefGoogle ScholarPubMed
21.Al-Ruzzeh, S, Ambler, G, Asimakopoulos, G et al. . Off-pump coronary artery bypass (OPCAB) surgery reduces risk stratified morbidity and mortality: a United Kingdom multi-center comparative analysis of early clinical outcome. Circulation 2003; 108 (Suppl 1): II1–II8.CrossRefGoogle ScholarPubMed
22.Meharwal, Zs, Mishra, YK, Kohli, V, Bapna, R, Singh, S, Trehan, N. Off-pump multivessel coronary artery surgery in high-risk patients. Ann Thorac Surg 2002; 74: 1353–1357.CrossRefGoogle ScholarPubMed
23.Van Dijk, D, Nierich, AP, Jansen, EW et al. . Early outcome after off-pump vs. on-pump coronary bypass surgery: results from a randomized study. Circulation 2001; 104: 1761–1766.CrossRefGoogle Scholar
24.Khan, NE, De Souza, A, Mister, R et al. . A randomized comparison of off-pump and on-pump multivessel coronary artery bypass surgery. N Engl J Med 2004; 350: 21–28.CrossRefGoogle ScholarPubMed
25.Nathoe, HM, van Dijk, D, Jansen, EW et al. . A comparison of on-pump and off-pump coronary bypass surgery in low risk patients. N Engl J Med 2003; 348: 394–402.CrossRefGoogle ScholarPubMed