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Thorac Cardiovasc Surg 2021; 69(07): 614-620
DOI: 10.1055/s-0041-1724036
Original Cardiovascular

Off-Pump Coronary Artery Bypass Reduces Cardiac Death in Patients with Peripheral Arteriopathy

Massimo Bonacchi
1   Cardiac Surgery, University Hospital Careggi, Firenze, Toscana, Italy
2   Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
,
Rosemary Howe
2   Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
,
Linda Renata Micali
2   Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
,
Daniel Weigel
2   Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
,
Orlando Parise
2   Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
,
Gianmarco Parise
2   Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
,
Sandro Gelsomino 
1   Cardiac Surgery, University Hospital Careggi, Firenze, Toscana, Italy
› Institutsangaben Funds There was no funding provided for this work.
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Abstract

Objective The aim of this study was to investigate whether the use of off-pump coronary artery bypass (OPCAB) may enhance early outcomes in subjects with peripheral artery disease (PAD) undergoing coronary artery bypass grafting (CABG).

Methods We employed a propensity-score (PS) method to compare early postoperative results of OPCAB and on-pump CABG patients with associated PAD. The study population consisted of 1,961 patients: 284 in the OPCAB and 1,677 in the on-pump CABG group. The inverse probability of treatment weighting was used as PS method.

Results The incidence of death (1.2% [95% confidence interval, CI: –0.9 to 3.3%], p = 0.262), stroke (2.2% [95% CI: –1.4 to 5.7%], p = 0.235), acute kidney disease (1.5% [95% CI: –3.8 to 6.8%], p = 0.586), limb ischemia (3.2% [95% CI: –0.6 to 7.0%], p = 0.315), and low output syndrome (1.2% [95% CI: –0.9 to 3.3%], p = 0.262) did not differ between the two groups. On the other hand, the rate of cardiac death (1.2% [95% CI: –0.1 to 2.3%], p = 0.038) was significantly higher in on-pump CABG group.

Conclusions The OPCAB procedure considerably reduced the occurrence of cardiac death after coronary revascularization. This finding might suggest that the OPCAB procedure should be considered as the first option in patients with higher cardiovascular risk scores. Further research is warranted.

Keywords

coronary revascularization - peripheral artery disease - peripheral ischemia

Author Contributions

Massimo Bonacchi, Rosemary Howe, and Linda Renata Micali equally contributed to the work. Massimo Bonacchi, Rosemary Howe, Linda Renata Micali, and Daniel Weigel acquired data. Massimo Bonacchi, Rosemary Howe, and Linda Renata Micali were involved in interpretation of the data, vouch for the data and analysis, and writing of the manuscript. They authored the first drafts of manuscript. Orlando Parise and Gianmarco Parise analyzed the data. Sandro Gelsomino designed the study, supervised its steps, and substantially revised the final version of the manuscript.


Supplementary Material



Publikationsverlauf

Eingereicht: 13. Juli 2020

Angenommen: 04. Januar 2021

Artikel online veröffentlicht:
24. Februar 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Dormandy J, Heeck L, Vig S. Lower-extremity arteriosclerosis as a reflection of a systemic process: implications for concomitant coronary and carotid disease. Semin Vasc Surg 1999; 12 (02) 118-122
    PubMedGoogle Scholar
  • 2 Aboyans V, Ricco JB, Bartelink MEL. et al; ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO), The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39 (09) 763-816
    CrossrefPubMedGoogle Scholar
  • 3 Hillis LD, Smith PK, Anderson JL. et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124 (23) e652-e735
    PubMedGoogle Scholar
  • 4 Birkmeyer JD, O'Connor GT, Quinton HB. et al; Northern New England Cardiovascular Disease Study Group. The effect of peripheral vascular disease on in-hospital mortality rates with coronary artery bypass surgery. J Vasc Surg 1995; 21 (03) 445-452
    CrossrefPubMedGoogle Scholar
  • 5 Chu D, Bakaeen FG, Wang XL. et al. The impact of peripheral vascular disease on long-term survival after coronary artery bypass graft surgery. Ann Thorac Surg 2008; 86 (04) 1175-1180
    CrossrefPubMedGoogle Scholar
  • 6 Nakamura T, Toda K, Miyagawa S. et al. Symptomatic peripheral artery disease is associated with decreased long-term survival after coronary artery bypass: a contemporary retrospective analysis. Surg Today 2016; 46 (11) 1334-1340
    CrossrefPubMedGoogle Scholar
  • 7 Mesh CL, Cmolik BL, Van Heekeren DW. et al. Coronary bypass in vascular patients: a relatively high-risk procedure. Ann Vasc Surg 1997; 11 (06) 612-619
    CrossrefPubMedGoogle Scholar
  • 8 Lamy A, Devereaux PJ, Prabhakaran D. et al; CORONARY Investigators. Off-pump or on-pump coronary-artery bypass grafting at 30 days. N Engl J Med 2012; 366 (16) 1489-1497
    CrossrefPubMedGoogle Scholar
  • 9 Shroyer AL, Grover FL, Hattler B. et al; Veterans Affairs Randomized On/Off Bypass (ROOBY) Study Group. On-pump versus off-pump coronary-artery bypass surgery. N Engl J Med 2009; 361 (19) 1827-1837
    CrossrefPubMedGoogle Scholar
  • 10 Rukosujew A, Klotz S, Reitz C, Gogarten W, Welp H, Scheld HH. Patients and complication with off-pump vs. on-pump cardiac surgery - a single surgeon experience. Interact Cardiovasc Thorac Surg 2007; 6 (06) 768-771
    CrossrefPubMedGoogle Scholar
  • 11 Rodrigues AJ, Evora PRB, Tubino PVA. On-pump versus off-pump coronary artery bypass graft surgery: what do the evidence show?. Rev Bras Cir Cardiovasc 2013; 28 (04) 531-537
    CrossrefPubMedGoogle Scholar
  • 12 Potger KC, McMillan D, Connolly T, Southwell J, Dando H, O'Shaughnessy K. Coronary artery bypass grafting: an off-pump versus on-pump review. J Extra Corpor Technol 2002; 34 (04) 260-266
    CrossrefPubMedGoogle Scholar
  • 13 Chaudhry MA, Omar Z, Latif F. Impact of renal dysfunction and peripheral arterial disease on post-operative outcomes after coronary artery bypass grafting. In: Aronow WS. ed. Artery Bypass. 2013. , chap. 25 DOI: 10.5772/54417
    CrossrefGoogle Scholar
  • 14 Ueki C, Sakaguchi G, Akimoto T, Ohashi Y, Sato H. On-pump beating-heart technique is associated with lower morbidity and mortality following coronary artery bypass grafting: a meta-analysis. Eur J Cardiothorac Surg 2016; 50 (05) 813-821
    CrossrefPubMedGoogle Scholar
  • 15 Puskas JD, Thourani VH, Kilgo P. et al. Off-pump coronary artery bypass disproportionately benefits high-risk patients. Ann Thorac Surg 2009; 88 (04) 1142-1147
    CrossrefPubMedGoogle Scholar
  • 16 Karthik S, Musleh G, Grayson AD. et al. Coronary surgery in patients with peripheral vascular disease: effect of avoiding cardiopulmonary bypass. Ann Thorac Surg 2004; 77 (04) 1245-1249
    CrossrefPubMedGoogle Scholar
  • 17 Yao XI, Wang X, Speicher PJ. et al. Reporting and guidelines in propensity score analysis: a systematic review of cancer and cancer surgical studies. J Natl Cancer Inst 2017; 109 (08) djw323
    PubMedGoogle Scholar
  • 18 Popovic B, Arnould MA, Selton-Suty C. et al. Comparison of two-year outcomes in patients undergoing isolated coronary artery bypass grafting with and without peripheral artery disease. Am J Cardiol 2009; 104 (10) 1377-1382
    CrossrefPubMedGoogle Scholar
  • 19 Sellke FW, DiMaio JM, Caplan LR. et al; American Heart Association. Comparing on-pump and off-pump coronary artery bypass grafting: numerous studies but few conclusions: a scientific statement from the American Heart Association Council on cardiovascular surgery and anesthesia in collaboration with the interdisciplinary working group on quality of care and outcomes research. Circulation 2005; 111 (21) 2858-2864
    CrossrefPubMedGoogle Scholar
  • 20 Kowalewski M, Pawliszak W, Malvindi PG. et al. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: meta-analysis. J Thorac Cardiovasc Surg 2016; 151 (01) 60-77.e1 , 58
    CrossrefPubMedGoogle Scholar
  • 21 Møller CH, Perko MJ, Lund JT. et al. Three-year follow-up in a subset of high-risk patients randomly assigned to off-pump versus on-pump coronary artery bypass surgery: the Best Bypass Surgery trial. Heart 2011; 97 (11) 907-913
    CrossrefPubMedGoogle Scholar
  • 22 Afilalo J, Rasti M, Ohayon SM, Shimony A, Eisenberg MJ. Off-pump vs. on-pump coronary artery bypass surgery: an updated meta-analysis and meta-regression of randomized trials. Eur Heart J 2012; 33 (10) 1257-1267
    CrossrefPubMedGoogle Scholar
  • 23 Hannan EL, Wu C, Smith CR. et al. Off-pump versus on-pump coronary artery bypass graft surgery: differences in short-term outcomes and in long-term mortality and need for subsequent revascularization. Circulation 2007; 116 (10) 1145-1152
    CrossrefPubMedGoogle Scholar
  • 24 Diegeler A, Börgermann J, Kappert U. et al; GOPCABE Study Group. Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. N Engl J Med 2013; 368 (13) 1189-1198
    CrossrefPubMedGoogle Scholar
  • 25 Deppe A-C, Arbash W, Kuhn EW. et al. Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of over 16,900 patients investigated in randomized controlled trials. Eur J Cardiothorac Surg 2016; 49 (04) 1031-1041 , discussion 1041
    CrossrefPubMedGoogle Scholar
  • 26 Bonacchi M, Parise O, Matteucci F. et al. Early outcomes following isolated coronary artery bypass surgery: influence of peripheral artery disease. J Card Surg 2019; 34 (12) 1470-1477
    CrossrefPubMedGoogle Scholar
  • 27 Le Tanneur C, Mongardon N, Haouache H. et al. Acute lower limb ischemia after coronary artery bypass grafting. J Cardiothorac Vasc Anesth 2015; 29 (06) 1624-1626
    CrossrefPubMedGoogle Scholar
  • 28 Gaudino M, Angelini GD, Antoniades C. et al; Arterial Grafting International Consortium (ATLANTIC) Alliance. Off-pump coronary artery bypass grafting: 30 years of debate. J Am Heart Assoc 2018; 7 (16) e009934
    CrossrefPubMedGoogle Scholar
  • 29 Brevetti G, Giugliano G, Brevetti L, Hiatt WR. Inflammation in peripheral artery disease. Circulation 2010; 122 (18) 1862-1875
    CrossrefPubMedGoogle Scholar
  • 30 Greilich PE, Brouse CF, Rinder HM. et al. Monocyte activation in on-pump versus off-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth 2008; 22 (03) 361-368
    CrossrefPubMedGoogle Scholar