Risk Factors of On-Pump Conversion during Off-Pump Coronary Artery Bypass Graft.
10.5090/kjtcs.2017.50.5.355
- Author:
Sung Sil YOON
1
;
Jung Hee BANG
;
Sang Seok JEONG
;
Jae Hwa JEONG
;
Jong Soo WOO
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine, Korea. graffon@donga.ac.kr
- Publication Type:Original Article
- Keywords:
Off-pump coronary artery bypass grafting;
Coronary artery bypass;
Myocardial ischemia;
Hemodynamic instability;
On pump conversion
- MeSH:
Cardiopulmonary Bypass;
Coronary Artery Bypass;
Coronary Artery Bypass, Off-Pump*;
Drainage;
Follow-Up Studies;
Heart Failure;
Humans;
Mortality;
Myocardial Ischemia;
Retrospective Studies;
Risk Factors*;
Stroke;
Transplants*
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2017;50(5):355-362
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Off-pump coronary artery bypass grafting (OPCABG) procedures can avoid the complications of an on-pump bypass. However, some cases unexpectedly require conversion to cardiopulmonary bypass during OPCABG. The risk factors associated with a sudden need for cardiopulmonary bypass were analyzed. METHODS: This retrospective study included 283 subjects scheduled for OPCABG from 2001 to 2010. These were divided into an OPCABG group and an on-pump conversion group. Preoperative, operative, and postoperative variables were compared between the 2 groups. RESULTS: Of the 283 patients scheduled for OPCABG, 47 (16%) were switched to on-pump coronary artery bypass grafting (CABG). The mortality of the both the OPCABG and on-pump conversion groups was not significantly different. The major risk factors for conversion to on-pump CABG were congestive heart failure (CHF) (odds ratio [OR], 3.5; p=0.029), ejection fraction (EF) <35% (OR, 4.4; p=0.012), and preoperative beta-blocker (BB) administration (OR, 0.3; p=0.007). The use of intraoperative (p=0.007) and postoperative (p=0.021) inotropics was significantly higher in the conversion group. The amount of postoperative drainage (p<0.001) and transfusion (p<0.001) also was significantly higher in the conversion group. There were no significant differences in stroke or cardiovascular complications between the groups over the course of short-term and long-term follow-up. CONCLUSION: Patients who undergo OPCABG and have CHF or a lower EF (<35%) are more likely to undergo on-pump conversion, while preoperative BB administration could help prevent conversions from OPCABG to on-pump CABG.
