Intraoperative crossover: the well-kept surgical secret to apparent surgical success

Cardiologists and patients contemplate the risk of proposed operations. Surgeons typically report outcomes on operations performed. Emergency intraoperative crossover from off- to on-pump coronary artery bypass grafting occurs uncommonly but has substantial rates of mortality and morbidity. Much of the reported perioperative benefit of off- compared with on-pump coronary artery bypass grafting is erased if data are presented by intention to treat and not by operation performed. Cardiologists and cardiac surgeons should share the responsibility for advising a patient to consent to a cardiac operation using honestly presented evidence of potential benefits and risks substantiated with information analyzed in patient-centric and not physician-centric ways.