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Published on: March 27, 2018
Thirty-day Outcomes of On-Pump and Off-Pump Coronary Artery Bypass Grafting: an Analysis of a Brazilian Sample by
Álvaro Rösler1, Gabriel Constantin1, Pedro Nectoux1
1Research Center of Cardiovascular Surgery, São Francisco Hospital, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Insights
This study found no significant difference in 30-day mortality or major complications between on-pump and off-pump coronary artery bypass grafting (CABG) in Brazil. Cardiopulmonary bypass (CPB) support was not an independent risk factor for mortality.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure.
- The use of cardiopulmonary bypass (CPB) during CABG is debated.
- Outcomes of on-pump versus off-pump CABG in Brazil are not well-established.
Purpose of the Study:
- To compare 30-day mortality and morbidity outcomes of on-pump and off-pump isolated CABG in Southern Brazil.
- To investigate the impact of CPB support on short-term outcomes after isolated CABG.
Main Methods:
- A single-center cohort study of 1,767 patients undergoing isolated CABG from January 2013 to December 2018.
- Propensity score matching was used to create homogeneous groups of on-pump (N=1,370) and off-pump (N=397) CABG patients.
- Descriptive, univariate, and logistic regression analyses were performed to compare outcomes and identify predictors of 30-day mortality.
Main Results:
- No significant differences were observed in baseline characteristics between the on-pump and off-pump groups after matching.
- Morbidity outcomes, including acute myocardial infarction, stroke, and major reoperation, did not differ significantly between the groups.
- 30-day mortality rates were similar (1.5% vs. 2.4%, P=0.401), and CPB support was not an independent predictor of 30-day mortality.
Conclusions:
- On-pump and off-pump isolated CABG demonstrate similar 30-day mortality and major morbidity outcomes in this large Brazilian cohort.
- Cardiopulmonary bypass support is not identified as an independent risk factor for 30-day mortality in this study population.
- These findings contribute to the understanding of CABG technique outcomes in a South American context.
Introduction:
Coronary artery bypass grafting (CABG) performed with and without cardiopulmonary bypass (CPB) support has been widely discussed in the literature. However, little is known about the outcomes of those techniques in Brazil. This study aims at exploring 30-day mortality and morbidity outcomes of on- and off-pump isolated CABG in a large sample from Southern Brazil.
Methods:
A single-center cohort with 1,767 patients undergoing isolated CABG (January 2013 - December 2018) was initially evaluated. Patients undergoing off-pump (N=397) and on-pump (N=1,370) CABG were identified. To obtain two completely homogeneous study groups, propensity score matching was used. The paired groups were compared by descriptive and univariate analyses. Then, logistic regression was used to verify the effects of on- and off-pump CABG on 30-day mortality.
Results:
None of the baseline characteristics showed significant difference between the groups (P>0.05). None of the analyzed morbidity outcomes showed any difference between the groups, including acute myocardial infarction (3.0% vs. 1.5%; P=0.192), stroke (2.4% vs. 4.2%; P=0.193), and major reoperation (0.6% vs. 0.3%; P=1.000), as well as the major adverse cardiovascular and cerebrovascular events composite outcome (6.3% vs. 7.5%; P=0.541). Mortality also did not differ (1.5% vs. 2.4%; P=0.401), and CPB support was not an independent predictor of risk for 30-day mortality (odds ratio: 2.052; 95% confidence interval: 0,609-6.913; P=0.246).
Conclusion:
After matching by propensity analyses, similar rates of on- and off-pump 30-day mortality and other major outcomes were observed. In addition, the use of CPB support was not an independent predictor of risk for the occurrence of 30-day mortality.
