HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Antonio Maria Calafiore Gabriele Di Giammarco Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Calafiore, A. M. Articles by Contini, M. Search for Related Content PubMed PubMed Citation Articles by Calafiore, A. M. Articles by Contini, M. Related Collections Coronary disease

Eur J Cardiothorac Surg 2003;24:953-960
© 2003 Elsevier Science NL

Myocardial revascularization with and without cardiopulmonary bypass: advantages, disadvantages and similarities

Division of Cardiac Surgery, University "G. D'Annunzio", S. Camillo de’ Lellis Hospital, via C. Forlanini 50, 66100 Chieti, Italy

Received 24 June 2003; received in revised form 29 July 2003; accepted 21 August 2003.

^* Corresponding author. Tel.: +39-0871-358653; fax: +39-0871-402239
e-mail: calafiore{at}unich.it

Objectives: Off-pump coronary artery bypass surgery is becoming increasingly popular although its effectiveness remains controversial. Our goal was to investigate the effectiveness of on-pump and off-pump coronary artery bypass surgery on early (30 days) and long-term (5 years) clinical outcome in two groups of patients selected using propensity scores. Methods: From November 1994 to December 2001, 4381 patients underwent isolated coronary surgery. Applying propensity score matching, 1922 patients were selected (off-pump n=961, on-pump n=961). Results: Stepwise logistic regression analysis showed that the use of cardiopulmonary bypass was an independent predictor for early death, cerebral vascular accident, early negative primary endpoints (ENPEP), and early major events (EME). Five years freedom from both events was similar in the two groups. However, freedom from acute myocardial infarction (AMI) in grafted areas was higher in the off-pump than in the on-pump patients, a possible explanation being the lower postoperative creatine kinase myocardial band (CKMB) release. Grouping all patients according to CKMB peak release also showed that patients with normal release values had higher freedom from all cardiac events investigated. A subgroup analysis of 59 patients converted from off-pump to on-pump showed higher early mortality, ENPEP, and EME. Conversion, however, did not affect late clinical outcome. Conclusions: These results suggest that off-pump surgery reduces early mortality and morbidity. Conversion to on-pump carries high in-hospital mortality and morbidity. Long-term clinical outcome is similar in the two groups; however, off-pump patients seemed to have a higher freedom from AMI in the grafted area which might be related to the lower CKMB peak release when compared with patients undergoing on-pump surgery.

Key Words: Coronary surgery • On-pump • Off-pump • Early clinical outcome • Late clinical outcome

This article has been cited by other articles:

				S. G Raja and G. D Dreyfus Current Status of Off-pump Coronary Artery Bypass Surgery Asian Cardiovasc Thorac Ann, April 1, 2008; 16(2): 164 - 178. [Abstract] [Full Text] [PDF]

				M. Masoumi, M. R Saidi, F. Rostami, H. Sepahi, and D. Roushani Off-Pump Coronary Artery Bypass Grafting in Left Ventricular Dysfunction Asian Cardiovasc Thorac Ann, February 1, 2008; 16(1): 16 - 20. [Abstract] [Full Text] [PDF]

				V. Falk and F. W. Mohr Minimally Invasive Myocardial Revascularization Card. Surg. Adult, January 1, 2008; 3(2008): 697 - 710. [Full Text]

				B. Bierbach, M. Meier, W. Kasper-Konig, A. Heimann, B. Alessandri, G. Horstick, H. Oelert, and O. Kempski Emboli Formation Rather Than Inflammatory Mediators Are Responsible for Increased Cerebral Water Content After Conventional and Assisted Beating-Heart Myocardial Revascularization in a Porcine Model Stroke, January 1, 2008; 39(1): 213 - 219. [Abstract] [Full Text] [PDF]

				M. Di Mauro, M. Gagliardi, A. L. Iaco, M. Contini, A. Bivona, P. Bosco, S. Gallina, and A. M. Calafiore Does Off-Pump Coronary Surgery Reduce Postoperative Acute Renal Failure? The Importance of Preoperative Renal Function Ann. Thorac. Surg., November 1, 2007; 84(5): 1496 - 1502. [Abstract] [Full Text] [PDF]

				J. Poling, W. Rees, V. Mantovani, S. Klaus, L. Bahlmann, V. Ziaukas, N. Hubner, and H. Warnecke Evaluation of myocardial metabolism with microdialysis during bypass surgery with cold blood- or Calafiore cardioplegia. Eur. J. Cardiothorac. Surg., October 1, 2006; 30(4): 597 - 603. [Abstract] [Full Text] [PDF]

				M. Tabata, S. Takanashi, T. Horai, T. Fukui, and Y. Hosoda Emergency conversion in off-pump coronary artery bypass grafting Interactive CardioVascular and Thoracic Surgery, October 1, 2006; 5(5): 555 - 559. [Abstract] [Full Text] [PDF]

				B. C. Reeves, R. Ascione, M. Caputo, and G. D. Angelini Morbidity and mortality following acute conversion from off-pump to on-pump coronary surgery. Eur. J. Cardiothorac. Surg., June 1, 2006; 29(6): 941 - 947. [Abstract] [Full Text] [PDF]

				K. Ishida, F. Kimura, M. Imamaki, A. Ishida, H. Shimura, H. Kohno, M. Sakurai, and M. Miyazaki Relation of inflammatory cytokines to atrial fibrillation after off-pump coronary artery bypass grafting. Eur. J. Cardiothorac. Surg., April 1, 2006; 29(4): 501 - 505. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, M. Di Mauro, G. Di Giammarco, G. Teodori, A. L. Iaco, V. Mazzei, G. Vitolla, and M. Contini Single Versus Bilateral Internal Mammary Artery for Isolated First Myocardial Revascularization in Multivessel Disease: Long-Term Clinical Results in Medically Treated Diabetic Patients Ann. Thorac. Surg., September 1, 2005; 80(3): 888 - 895. [Abstract] [Full Text] [PDF]

				A. M. Calafiore, G. Di Giammarco, G. Teodori, A. L. Iaco, M. Pano, M. Contini, G. Vitolla, and M. Di Mauro Bilateral internal thoracic artery grafting with and without cardiopulmonary bypass: Six-year clinical outcome J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 340 - 345. [Abstract] [Full Text] [PDF]

				M. Di Mauro, A. L. Iaco, M. Contini, G. Teodori, G. Vitolla, M. Pano, G. Di Giammarco, and A. M. Calafiore Reoperative Coronary Artery Bypass Grafting: Analysis of Early and Late Outcomes Ann. Thorac. Surg., January 1, 2005; 79(1): 81 - 87. [Abstract] [Full Text] [PDF]

				R. Pandey, A. D. Grayson, D. M. Pullan, B. M. Fabri, and W. C. Dihmis Total arterial revascularisation: effect of avoiding cardiopulmonary bypass on in-hospital mortality and morbidity in a propensity-matched cohort Eur. J. Cardiothorac. Surg., January 1, 2005; 27(1): 94 - 98. [Abstract] [Full Text] [PDF]

				T. Athanasiou, O. Aziz, O. Mangoush, S. Al-Ruzzeh, S. Nair, V. Malinovski, R. Casula, and B. Glenville Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited Eur. J. Cardiothorac. Surg., October 1, 2004; 26(4): 701 - 710. [Abstract] [Full Text] [PDF]