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Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial
Jean-Francois Légaré1, Karen J Buth, Gregory M Hirsch
1Division of Cardiovascular Surgery, Dalhousie University, 1796 Summer Str. Rm 2006, New Halifax Infirmary, Halifax, NS, Canada B3H 3A7. jean.legare@cdha.nshealth.ca
Summary
Off-pump coronary artery bypass grafting (OPCAB) conversion to on-pump coronary artery bypass grafting (CABG) occurred in 13% of patients and was linked to higher mortality. Elevated BMI was associated with conversion.
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes
- Minimally Invasive Cardiac Surgery
Background:
- Off-pump coronary artery bypass (OPCAB) surgery has become increasingly feasible due to advancements in cardiac stabilization devices.
- Conflicting evidence exists regarding the risks and adverse events associated with converting OPCAB to conventional coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB).
Purpose of the Study:
- To evaluate the rate and adverse events of conversion from OPCAB to CABG with CPB.
- To analyze conversion data within the context of a randomized controlled trial comparing CABG with and without CPB.
Main Methods:
- A prospective randomized controlled trial involving 300 patients undergoing CABG surgery.
- Patients were randomized to either CABG with CPB (n=150) or OPCAB (n=150).
- Patients who could not complete OPCAB were classified as the conversion group.
Main Results:
- Twenty patients (13%) were converted from OPCAB to CABG with CPB.
- Reasons for conversion included hemodynamic instability (14/20), small target vessels (5/20), and inadequate visualization (1/20).
- Converted patients experienced significantly higher in-hospital mortality (10% vs. 0%, P=0.01), required more inotropes (P=0.001), and received more blood transfusions (P=0.05).
- Elevated body mass index (BMI) was the only identified pre-operative predictor of conversion.
Conclusions:
- The conversion rate from OPCAB to CABG with CPB in this randomized trial was 13%.
- Conversion from OPCAB to CABG with CPB is associated with an increased risk of mortality and adverse events.
- Elevated BMI is a potential risk factor for conversion during OPCAB surgery.