Document Detail


On-pump beating-heart coronary artery bypass: a propensity matched analysis.
MedLine Citation:
PMID:  17383341     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: It remains unclear how cardioplegic arrest affects surgical results after coronary artery bypass grafting surgery (CABG). This study compares early outcomes after on-pump beating-heart CABG and conventional CABG. METHODS: From 2002 to 2005, 114 patients underwent on-pump beating-heart CABG. Multivariate logistic regression revealed five characteristics according to which technique is liable to be used: history of cerebral infarction, urgent or emergent operation, lower ejection fraction, preoperative creatine kinase, and lower number of diseased vessels. The early clinical outcome for these patients was compared against 114 conventional CABG patients, matched using a propensity score constructed with these five significant variables and with two nonsignificant variables: history of diabetes mellitus and hypertension. RESULTS: On-pump beating-heart CABG significantly reduced the duration of operation and cardiopulmonary bypass, total blood loss, and peak creatine kinase (p < 0.05). The number of patients requiring additional intra-aortic balloon pump support was significantly lower in the on-pump beating-heart CABG group (2 versus 13, p < 0.01). No patients required percutaneous cardiopulmonary support after on-pump beating-heart CABG, whereas 4 patients needed it after conventional CABG. Complete revascularization was significantly lower (42.1% versus 77.2%, p < 0.0001), but in-hospital mortality was less in the on-pump beating-heart CABG group (2.6% versus 9.6%, p < 0.05). No significant difference was found in morbidity including stroke, renal failure, mediastinitis, and prolonged ventilation. CONCLUSIONS: On-pump beating-heart CABG can be performed safely, including on high-risk patients. Use of cardiopulmonary bypass and the elimination of cardioplegic arrest may be of most benefit to hemodynamically unstable patients.
Authors:
Shinichi Mizutani; Akio Matsuura; Ken Miyahara; Tadahito Eda; Akemi Kawamura; Teruaki Yoshioka; Katsuhiko Yoshida
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  83     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-26     Completed Date:  2007-04-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1368-73     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular Surgery, Aichi Cardiovascular and Respiratory Center, Ichinomiya, Aichi, Japan. smizutan@cf7.so-net.ne.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiopulmonary Bypass
Case-Control Studies
Confidence Intervals
Coronary Angiography
Coronary Artery Bypass, Off-Pump / adverse effects,  methods*
Coronary Disease / mortality,  radiography,  surgery*
Female
Follow-Up Studies
Heart Arrest, Induced*
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Postoperative Complications
Probability
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Rate
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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