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Eur J Cardiothorac Surg 2006;29:941-947
© 2006 Elsevier Science NL

Morbidity and mortality following acute conversion from off-pump to on-pump coronary surgery

Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, UK

Received 19 December 2005; received in revised form 8 March 2006; accepted 10 March 2006.

^_* Corresponding author. Tel.: +44 117 928 3145; fax: +44 117 929 9737. (Email: g.d.angelini{at}bristol.ac.uk).

Objective: Many studies have described reduced morbidity in hospital and equivalent midterm outcomes with off-pump coronary artery bypass (OPCAB) surgery compared to conventional CABG (CABG-CPB). However, OPCAB is sometimes converted acutely to CABG-CPB. We describe the risk of acute conversion and compare patients’ outcomes for acutely converted OPCAB with unconverted OPCAB and CABG-CPB. Methods: Consecutive acute conversions, i.e. OPCAB patients in whom CPB was instituted urgently for hemodynamic or electrical instability, cardiac arrest or uncontrolled bleeding, were compared with propensity-matched unconverted OPCAB and CABG-CPB patients. Relative risks of death and complications in hospital, and subsequent survival were estimated. Results: The risk of acute conversion between 1996 and 2004 was 1.1% (27/2492): 5.1% in the first 2 years, 2.2% in the third year and 0.8% subsequently. Odds ratios for death in hospital compared to unconverted OPCAB and CABG-CPB were 4.4 (95% confidence interval (CI) 0.67–29.1) and 4.7 (95% CI 1.03–21.1), respectively, and ranged from 0 to 4.5 for serious complications. Converted patients had an increased hazard of death for 3 years after surgery compared to unconverted OPCAB (hazard ratio 3.21, 95% CI 1.20–8.59) and CABG-CPB patients (hazard ratio 3.23, 95% CI 1.41–7.39). Conclusions: Experienced OPCAB surgeons have a low risk of acute conversion. Acutely converted patients have a moderately increased risk of death and serious complications in hospital. These risks are difficult to quantify precisely because conversion is rare.

Key Words: CABG • OPCAB • Conversion • Mortality • Morbidity

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