Document Detail


On-pump versus off-pump surgical revascularization for left main stem stenosis: risk adjusted outcomes.
MedLine Citation:
PMID:  15975355     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Recent publications have shown coronary surgery is safe and effective in patients with critical left main stem stenosis when using off-pump coronary surgery techniques. However, these studies were small and did not adjust for differences in case mix. METHODS: Between April 1997 and March 2003, 1,197 consecutive patients with critical left main stem stenosis (> 50%) underwent coronary surgery. Two hundred and fifty-nine (21.6%) of these patients had off-pump coronary surgery, while 938 (78.4%) received on-pump coronary surgery. Multivariate logistic regression and Cox proportional hazards analysis were used to assess the effect of off-pump coronary surgery on outcomes, while adjusting for patient characteristics (treatment selection bias). Treatment selection bias was controlled by constructing a propensity score from core patient characteristics. The propensity score was the probability of receiving off-pump coronary surgery and was included along with the comparison variable in the multivariable analyses of outcome. RESULTS: After adjusting for the propensity score, the requirement for inotropic support (22.4% versus 35.3%; p < 0.001) or a prolonged length of stay (5.3% versus 9.3%; p = 0.034) were significantly reduced after receiving off-pump coronary surgery. There was a trend to suggest that off-pump patients had a lower incidence of stroke and chest infection. The adjusted freedom from death in off-pump patients at 2 years was 94.6% compared with 93.6% for on-pump patients (p = 0.54). CONCLUSIONS: After risk adjustment, patients with critical left main stem stenosis can undergo off-pump coronary surgery safely, with results comparable with on-pump coronary surgery.
Authors:
John C Y Lu; Antony D Grayson; D Mark Pullan
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  80     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-06-24     Completed Date:  2006-08-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  136-42     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiothoracic Surgery, The Cardiothoracic Centre, Liverpool, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Artery Bypass / mortality*
Coronary Artery Bypass, Off-Pump / mortality
Coronary Stenosis / surgery*
Female
Humans
Male
Middle Aged
Risk Assessment
Treatment Outcome
Comments/Corrections
Comment In:
Ann Thorac Surg. 2005 Jul;80(1):142-3   [PMID:  15975356 ]

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


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