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Published on: September 15, 2023
Long-Term Outcomes after Redo Coronary Artery Bypass Grafting: A Propensity-Matched Analysis of On-Pump and Off-Pump
Carl Thaddäus Braun1, Lena Steins1, Malee Julie Scherer1
1Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Clinic for Cardiovascular and Thoracic Surgery, Germany.
Insights
Off-pump redo coronary artery bypass grafting (CABG) offers shorter operative times and reduced transfusions compared to on-pump surgery. Both strategies demonstrate similar long-term survival and safety profiles for redo-CABG patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Surgery
Background:
- Redo coronary artery bypass grafting (redo-CABG) presents significant technical challenges and increased perioperative risks compared to primary CABG.
- The benefit of avoiding cardiopulmonary bypass (CPB) during redo-CABG remains an area of active investigation.
- Optimizing surgical strategies for redo-CABG is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the perioperative and long-term outcomes of off-pump versus on-pump redo-CABG.
- To evaluate the safety and efficacy of different bypass strategies in a high-volume surgical center.
- To identify predictors of survival following redo-CABG.
Main Methods:
- Retrospective analysis of 370 patients undergoing redo-CABG between 2009 and 2024.
- Propensity score matching was utilized to balance preoperative covariates between off-pump and on-pump groups.
- Survival analyses and assessment of revascularization completeness were performed.
Main Results:
- Off-pump redo-CABG was associated with significantly shorter operative times and reduced red blood cell transfusion requirements.
- Lower levels of myocardial injury biomarkers (CK-MB, troponin) were observed in the off-pump group.
- In-hospital mortality, stroke, myocardial infarction, and long-term survival rates were comparable between the off-pump and on-pump strategies.
Conclusions:
- Off-pump redo-CABG is a safe and effective alternative to on-pump surgery, with similar long-term outcomes.
- The choice between off-pump and on-pump strategies for redo-CABG should be individualized based on patient-specific factors and surgeon expertise.
- Surgical strategy alone was not an independent predictor of long-term survival in multivariable analysis.
Background:
Redo coronary artery bypass grafting (redo-CABG) is technically challenging and carries a higher perioperative risk than primary CABG. Whether avoiding cardiopulmonary bypass is beneficial in this setting remains unclear. We compared perioperative and long-term outcomes of off-pump versus on-pump redo-CABG in a high-volume center.
Methods:
All patients undergoing redo-CABG between 2009 and 2024 were retrospectively analyzed. Perioperative, in-hospital, and long-term outcomes were evaluated. Propensity score matching was performed using preoperative covariates. Survival analyses included a subgroup of beating-heart on-pump cases. Completeness of revascularization was likewise assessed.
Results:
Among 370 patients (175 off-pump group; 195 on-pump group), 184 were propensity score-matched. Off-pump surgery had shorter operative time (183 vs. 208 min; p = 0.015) and reduced red blood cell transfusion requirements (3 vs. 5 units; p = 0.014). Myocardial injury biomarkers were reduced with off-pump surgery (CK-MB: 45 vs. 68 ng/mL, p = 0.01; high-sensitivity troponin: 3,388 vs. 7,744 ng/L, p = 0.001). In-hospital mortality was comparable (off-pump group 2.2 vs. 1.1% in the on-pump group; p = 0.621; relative risk: 1.34). Rates of stroke, myocardial infarction, cardiopulmonary resuscitation, and hemofiltration did not differ. Five-year repeat revascularization rates were similar (off-pump group: 18.5 vs. 19.6% in the on-pump group; p = 0.854). Long-term survival did not differ between strategies. In multivariable analysis, surgical strategy (off-pump, on-pump, beating-heart) was not an independent predictor of survival.
Conclusion:
Off-pump redo-CABG is safe and yields outcomes similar to on-pump surgery. Pump strategy should be individualized based on patient's anatomy and surgical expertise.
