Conversion from Off to On-Pump Coronary Artery Bypass Grafting. Is it Avoidable?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Anesthesiology

Background:

• Off-pump coronary artery bypass grafting (OPCAB) is increasingly utilized due to technological advancements.
• Conversions from OPCAB to on-pump CABG (ONCAB) can be necessary in certain surgical scenarios.
• Identifying risk factors for conversion is crucial for patient safety and surgical planning.

Purpose of the Study:

• To identify risk factors associated with emergent conversion from OPCAB to ONCAB.
• To evaluate the short-term outcomes of patients undergoing conversion.
• To inform clinical decision-making regarding OPCAB in high-risk patients.

Main Methods:

• Retrospective analysis of 100 patients who underwent OPCAB between August 2018 and July 2019.
• Data collection included preoperative, intraoperative, and postoperative variables.
• Comparison of variables between patients who required conversion and those who did not.

Main Results:

• A 9% conversion rate from OPCAB to ONCAB was observed.
• Arrhythmias were the most common reason for emergent conversion (5 cases).
• Higher New York Heart Association (NYHA) functional classification and chronic obstructive pulmonary disease (COPD) were significantly associated with increased conversion risk.

Conclusions:

• Emergency conversion during OPCAB is associated with increased morbidity and mortality.
• Patients with COPD and higher NYHA functional status are at higher risk for emergent conversion.
• Careful consideration of risks and benefits is warranted when selecting OPCAB for patients with COPD and advanced NYHA classification.