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Eur J Cardiothorac Surg 2003;24:66-71
© 2003 Elsevier Science NL
a Department of Cardiothoracic Surgery, The Cardiothoracic Centre – Liverpool, Liverpool, UK
b Department of Cardiothoracic Surgery. Manchester Royal Infirmary, Manchester, UK
c Department of Research and Development, The Cardiothoracic Centre – Liverpool, Liverpool, UK
Received 30 December 2002; received in revised form 27 March 2003; accepted 1 April 2003.
* Corresponding author. Tel.: +44-151-293-2397; fax: +44-151-220-8573
e-mail: brian.fabri{at}ctc.nhs.uk
Objective: Non-elective coronary artery surgery (emergent/salvage or urgent) carries an increased risk in most risk-stratification models. Off-pump coronary surgery is increasingly used in non-elective cases. We aimed to investigate the effect of avoiding cardiopulmonary bypass on outcomes following non-elective coronary surgery. Methods: Of the 3771 consecutive coronary artery bypass procedures performed by five surgeons between April 1997 and March 2002, 828 (22%) were non-elective and 417 (50.4%) of these patients had off-pump surgery. Multivariate logistic regression was used to assess the effect of off-pump on in-hospital outcomes, while adjusting for treatment selection bias. Treatment selection bias was controlled for by constructing a propensity score from core patient characteristics, which was the probability of avoiding cardiopulmonary bypass. The C statistic for this model was 0.8. Results: Off-pump patients were more likely to be hypertensive, stable, had less extensive disease and better left ventricular function. The left internal mammary artery was used in 91.8% (n=383) of off-pump patients compared to 79.3% (n=326) of on-pump cases (P<0.001). After adjusting for the propensity score, no difference in in-hospital mortality was observed between off-pump and on-pump (adjusted odds ratio (OR) 0.83 (95% confidence intervals (CI) 0.36–1.93); P=0.667). Off-pump patients were less likely to require intra-aortic balloon pump support (adjusted OR 0.44 (95% CI 0.21–0.96); P=0.039), less likely to have renal failure (adjusted OR 0.44 (95% CI 0.22–0.90); P=0.025), and have shorter lengths of stay (adjusted OR 0.51 (95% CI 0.37–0.70); P<0.001). Other morbidity outcomes were similar in both groups. Conclusions: In this experience, off-pump coronary surgery in non-elective patients is safe with acceptable results. Non-elective off-pump patients have a significantly reduced incidence of renal failure, and shorter post-operative stays compared to on-pump coronary artery bypass surgery.
Key Words: Off-pump • Coronary artery bypass surgery • Non-elective • Mortality • Morbidity • Risk adjustment
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