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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2017 Nov 16

DOI: 10.23736/S0021-9509.17.10058-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Outcomes of beating heart on pump utilizing a miniature bypass circuit versus off pump cardiac bypass at a veterans affairs medical center

Matthew SKANCKE 1, Kendal ENDICOTT 1, Richard AMDUR 3, Michael GREENBERG 2, Gregory TRACHIOTIS 1, 3

1 Division of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington, DC, USA; 2 Division of Cardiology, Veterans Affairs Medical Center, Washington, DC, USA; 3 Division of Cardiothoracic Surgery, the George Washington University, Washington, DC, USA


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BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) helps reduce systemic inflammatory changes by maintaining native pulsatile flow. This analysis evaluates the outcomes of OPCAB at a Veterans Affairs Medical Center (VAMC) and evaluates the use of beating heart on-pump (BHOP) bypass grafting as an empiric therapy for high-risk patients.
METHODS: We performed a retrospective analysis of 756 patients who underwent coronary bypass grafting between 2004-2015 at a single VAMC. This group was subdivided into BHOP (n=60) versus OPCAB (n=696). Analysis was performed using multivariate regression modeling with p=0.05 holding statistical significance.
RESULTS: Both cohorts were predominantly male with an average age of 65 years and average body mass index of 30 kg/m2. Individuals in the BHOP group were more likely to have COPD and resting ST Depressions pre-operatively. Operative time was longer and average number of conduits was higher for BHOP cases compared to OPCAB cases respectively. After controlling for differences between cohorts, multivariate regression analysis showed a protective effect of both BHOP (OR 0.325, p=0.035; OR 0.323, p=0.031) and two (OR 0.385, p<0.001; OR 0.539, p=0.018) and three (OR 0.154, p<0.001; OR 0.315, p<0.001) vessel revascularization on three and six-year mortality following revascularization.
CONCLUSIONS: Postoperative survival following BHOP is superior to OPCAB when BHOP is used empirically with no difference in short-term mortality. Empiric use of BHOP should be considered for high risk coronary revascularization.


KEY WORDS: Beating Heart - Off-pump - Cardiac bypass - Veterans

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Publication History

Article first published online: November 16, 2017
Manuscript accepted: November 8, 2017
Manuscript revised: September 22, 2017
Manuscript received: June 2, 2017

Per citare questo articolo

Skancke M, Endicott K, Amdur R, Greenberg M, Trachiotis G. Outcomes of beating heart on pump utilizing a miniature bypass circuit versus off pump cardiac bypass at a veterans affairs medical center. J Cardiovasc Surg 2017 Nov 16. DOI: 10.23736/S0021-9509.17.10058-3

Corresponding author e-mail

gregory.trachiotis@va.gov