Postoperative outcomes of on- vs off-pump CABG in patients with HFrEF: a nationwide cohort study in Taiwan
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Published on: March 27, 2018
Yu-Hern Tan1, Huai-Hsuan Tung1, Shih-Chieh Chien2
1Division of Cardiovascular Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei City, Taiwan.
Insights
For heart failure patients undergoing coronary artery bypass grafting, off-pump CABG (OPCAB) showed no significant difference in mortality or complications compared to on-pump CABG (ONCAB). However, OPCAB was linked to higher sepsis risk in specific patient subgroups.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Heart Failure Management
Background:
- Optimal surgical strategy for coronary artery bypass grafting (CABG) in patients with heart failure with reduced ejection fraction (HFrEF) remains unclear.
- Comparing off-pump CABG (OPCAB) versus on-pump CABG (ONCAB) is crucial for this vulnerable population.
Purpose of the Study:
- To compare postoperative outcomes between OPCAB and ONCAB in patients with HFrEF undergoing CABG.
- To evaluate the association of surgical approach with mortality and complications.
Main Methods:
- Retrospective cohort study of adults with HFrEF undergoing CABG (2001-2021) using the National Health Insurance Research Database.
- Primary outcome: all-cause mortality. Secondary outcomes: postoperative complications.
- Multivariable logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- Analysis of 855 patients (OPCAB n=252; ONCAB n=603).
- After adjustment, OPCAB was not significantly associated with 30-day or 1-year all-cause mortality compared to ONCAB.
- No significant differences in major postoperative complications were observed, though OPCAB showed higher sepsis odds in patients with <3-vessel disease or cerebrovascular disease.
Conclusions:
- Surgical approach (OPCAB vs. ONCAB) was not independently associated with 30-day mortality, 1-year mortality, or major postoperative complications in HFrEF patients undergoing CABG.
- Further prospective studies with detailed data are warranted to confirm these findings.
Objective:
The optimal surgical strategy for coronary artery bypass grafting (CABG) in patients with heart failure with reduced ejection fraction (HFrEF) is uncertain. This study aimed to compare postoperative outcomes between off-pump/on-pump CABG (OPCAB vs ONCAB) in patients with HFrEF.
Methods:
This retrospective cohort study included adults with HFrEF undergoing CABG from the National Health Insurance Research Database, 2001-2021. Primary outcome was all-cause mortality. Secondary outcomes were postoperative complications. Logistic regression was used to determine associations by estimating odds ratios (ORs) with 95% confidence intervals (CIs).
Results:
Data of 855 patients were analyzed (OPCAB n = 252; ONCAB n = 603). After multivariable adjustment, OPCAB was not significantly associated with all-cause mortality within 30 days compared with ONCAB. OPCAB was also not significantly associated with 31-day to one-year all-cause mortality, overall cardiovascular events, IS/TIA, AKI, infection other than pneumonia, sepsis, or pneumonia compared with ONCAB. In stratified analyses, OPCAB was associated with higher odds of sepsis among patients with less extent of coronary artery disease (<3-vessel disease) (aOR = 3.16, 95% CI: 1.24-8.07) and among those with cerebrovascular disease (aOR = 3.40, 95% CI: 1.13-10.21).
Conclusions:
In patients with HFrEF undergoing CABG, surgical approach (OPCAB vs ONCAB) was not independently associated with 30-day mortality, 1-year mortality, or major postoperative complications after adjustment. Further prospective studies with detailed operative and patient-level data are still warranted.
