Related Experiment Video
Updated: Aug 21, 2026
Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Emergency conversion to cardiopulmonary bypass during attempted off-pump revascularization results in increased
Nirav C Patel1, Nilesh U Patel, Didier F Loulmet
1Section of Cardiothoracic Surgery, Lenox Hill Hospital, 130 E 77th Street, New York, NY 10021, USA. niravcpatel@aol.com
Insights
Emergency conversion to cardiopulmonary bypass during off-pump coronary bypass surgery significantly increases mortality and morbidity. This unpredictable event
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
Background:
- Off-pump coronary bypass (OPCAB) surgery aims to avoid cardiopulmonary bypass (CPB).
- Emergency conversion to CPB during OPCAB is associated with adverse outcomes.
Purpose of the Study:
- To evaluate outcomes and predictors of emergency conversion to CPB during OPCAB surgery.
Main Methods:
- Retrospective analysis of 1678 isolated OPCAB operations (1999-2002).
- Data collected from the New York State Cardiac Surgery Reporting System.
- Multivariate regression analysis to identify predictors of conversion.
Main Results:
- 50 patients (2.97%) required emergency conversion to CPB.
- Converted patients had significantly higher in-hospital mortality (12% vs 1.47%) and major morbidity (stroke, renal failure, wound infection, respiratory failure).
- Incidence of conversion decreased with surgeon experience and use of a cardiac positioning device.
Conclusions:
- Emergency conversion to CPB during OPCAB is linked to substantially higher morbidity and mortality.
- Converted patients should be included in the OPCAB group for comparative studies.
- Conversion is unpredictable; incidence decreases with experience and use of specialized devices.
Objective:
We sought to evaluate outcomes and predictors of emergency conversion to cardiopulmonary bypass during attempted off-pump coronary bypass surgery.
Methods:
From January 1999 through July 2002, 1678 consecutive isolated coronary artery bypass operations were performed at Lenox Hill Hospital, with the intention to treat all patients with off-pump coronary bypass surgery. Fifty (2.97%) patients required urgent conversion to cardiopulmonary bypass. All the preoperative, intraoperative, and postoperative variables were collected and analyzed in accordance with the New York State Cardiac Surgery Reporting System. Multivariate regression analysis was performed to determine predictors for conversion.
Results:
In-hospital mortality and major morbidity were significantly lower in the nonconverted group compared with the converted patients (mortality: 1.47% [n = 24] vs 12% [n = 6], P = .001; stroke: 1.1% [n = 18] vs 6% [n = 3], P = .02; renal failure: 1.23% [n = 20] vs 6% [n = 3], P = .02; deep sternal wound infection: 1.54% [n = 25] vs 8% [n = 4], P = .009; respiratory failure: 3.75% [n = 61] vs 28% [n = 14], P < .0001; nonconverted vs converted patients, respectively). The annual incidence of conversion decreased during the study period. There was a significant reduction in the incidence of conversion after routine use of a cardiac positioning device to performing lateral and inferior wall grafts (4.2% [n = 27] vs 2.3% [n = 23], P = .04). None of the preoperative variables were independent predictors of conversion on multivariate regression analysis.
Conclusions:
Because emergency conversion to cardiopulmonary bypass during attempted off-pump coronary bypass surgery results in significantly higher morbidity and mortality, studies comparing off-pump coronary bypass surgery with conventional coronary artery surgery should include converted patients in the off-pump group. In our experience, emergency conversion is an unpredictable event. The incidence of conversion decreases with increasing experience of surgeons in performing off-pump coronary surgery and use of a cardiac positioning device.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:21Cardiac Catheterization II: Right Heart Catheterization