Off-Pump Conversion: In-hospital Mortality and Long-Term Survival

Area of Science:

• Cardiovascular Surgery
• Surgical Outcomes Research

Background:

• Ongoing debate exists regarding the risks and benefits of off-pump coronary artery bypass grafting (CABG).
• The outcomes for patients requiring conversion from off-pump to on-pump CABG are not well-established, particularly for long-term survival.

Purpose of the Study:

• To investigate the impact of conversion from off-pump to on-pump CABG on in-hospital mortality.
• To evaluate the effect of this conversion on long-term survival rates.

Main Methods:

• A multivariate and propensity analysis was conducted on 15,704 isolated CABG patients, with a focus on 5,353 who underwent off-pump CABG.
• In-hospital mortality and long-term survival were assessed for patients who were converted from off-pump to on-pump procedures.

Main Results:

• Of 5,353 off-pump CABG patients, 73 (1.4%) were converted. Initial univariate analysis showed increased in-hospital mortality and reduced long-term survival in converted patients.
• However, logistic regression and Cox analysis indicated no significant impact of conversion on in-hospital mortality or long-term survival.
• Propensity analysis further confirmed that conversion did not significantly affect in-hospital mortality or long-term survival.

Conclusions:

• Conversion from off-pump to on-pump CABG surgery, when performed by dedicated off-pump specialist teams, does not adversely affect in-hospital mortality.
• Long-term survival rates are also not significantly reduced in patients who undergo conversion from off-pump to on-pump CABG.