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The Journal of Cardiovascular Surgery 2019 June;60(3):388-95

DOI: 10.23736/S0021-9509.18.10697-5


lingua: Inglese

Mid- and long-term prognosis of off- vs. on-pump coronary artery bypass graft in patients with multisite artery disease

Louis LE BIVIC 1, 2, 3, Julien MAGNE 1, 2, 3, Jean-David BLOSSIER 1, 2, 3, Alessandro PICCARDO 1, 2, 3, Hélène WOJTYNA 1, 2, 3, Philippe LACROIX 1, 2, 3, Dania MOHTY 1, 2, 3, Elisabeth CORNU 1, 2, 3, Alexandre LE GUYADER 1, 2, 3, Victor ABOYANS 1, 2, 3

1 CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France; 2 INSERM 1094, Faculty of Medicine, Limoges, France; 3 CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France

BACKGROUND: Among patients with coronary artery disease (CAD), around 25% have multisite artery disease (MSAD). Patients with CAD and MSAD are at higher risk of peri-operative and long-term cardiovascular events. Whether off-pump coronary bypass grafting (CABG) can improve their prognosis is unknown. We aimed to assess the benefits of off- vs. on-pump cardiac surgery in patients undergoing CABG, according to coexistence of extra-cardiac artery disease.
METHODS: Between April 1998 and September 2008, 1221 patients undergoing CABG without any other intervention were enrolled. Overall death and major cardiovascular events were recorded at 1-month and during long-term follow-up. A propensity score (PS), derived from all relevant variables (P<0.25) associated with on-pump as compared to off-pump CABG, and representing the likelihood for each individual patient to receive off-pump CABG, was calculated.
RESULTS: MSAD was observed in 279 patients (23%). Off-pump CABG was performed in 208 (17%) patients. The median follow-up was 7.6 years. The 10-year mortality was significantly lower in off- vs. on-pump CABG group (74±4% vs. 68±2%, P=0.024). In patients with MSAD, there was a trend for better survival for off- vs. on-pump CABG (63±8% vs. 50±4%, P=0.078). After adjustment for PS, we found no further difference between on- and off-pump CABG both in the whole cohort (HR=1.30, P=0.10), as well as in MSAD patients (HR=1.51, P=0.14).
CONCLUSIONS: Patients with MSAD receiving CABG are at worst prognostic than those with isolated CAD. In these patients, we found no significant difference in the long-term mortality and cardiovascular events between on- and off-pump CABG.

KEY WORDS: Atherosclerosis; Coronary artery disease; Coronary artery bypass

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