Thorac Cardiovasc Surg
DOI: 10.1055/s-0041-1724036
Original Cardiovascular

Off-Pump Coronary Artery Bypass Reduces Cardiac Death in Patients with Peripheral Arteriopathy

Massimo Bonacchi
1  Cardiac Surgery, University Hospital Careggi, Firenze, Toscana, Italy
2  Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
,
Rosemary Howe
2  Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
,
Linda Renata Micali
2  Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
,
Daniel Weigel
2  Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
,
Orlando Parise
2  Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
,
Gianmarco Parise
2  Cardiothoracic Surgery Department, Maastricht University Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
,
1  Cardiac Surgery, University Hospital Careggi, Firenze, Toscana, Italy
› Author Affiliations
Funds There was no funding provided for this work.

Abstract

Objective The aim of this study was to investigate whether the use of off-pump coronary artery bypass (OPCAB) may enhance early outcomes in subjects with peripheral artery disease (PAD) undergoing coronary artery bypass grafting (CABG).

Methods We employed a propensity-score (PS) method to compare early postoperative results of OPCAB and on-pump CABG patients with associated PAD. The study population consisted of 1,961 patients: 284 in the OPCAB and 1,677 in the on-pump CABG group. The inverse probability of treatment weighting was used as PS method.

Results The incidence of death (1.2% [95% confidence interval, CI: –0.9 to 3.3%], p = 0.262), stroke (2.2% [95% CI: –1.4 to 5.7%], p = 0.235), acute kidney disease (1.5% [95% CI: –3.8 to 6.8%], p = 0.586), limb ischemia (3.2% [95% CI: –0.6 to 7.0%], p = 0.315), and low output syndrome (1.2% [95% CI: –0.9 to 3.3%], p = 0.262) did not differ between the two groups. On the other hand, the rate of cardiac death (1.2% [95% CI: –0.1 to 2.3%], p = 0.038) was significantly higher in on-pump CABG group.

Conclusions The OPCAB procedure considerably reduced the occurrence of cardiac death after coronary revascularization. This finding might suggest that the OPCAB procedure should be considered as the first option in patients with higher cardiovascular risk scores. Further research is warranted.

Author Contributions

Massimo Bonacchi, Rosemary Howe, and Linda Renata Micali equally contributed to the work. Massimo Bonacchi, Rosemary Howe, Linda Renata Micali, and Daniel Weigel acquired data. Massimo Bonacchi, Rosemary Howe, and Linda Renata Micali were involved in interpretation of the data, vouch for the data and analysis, and writing of the manuscript. They authored the first drafts of manuscript. Orlando Parise and Gianmarco Parise analyzed the data. Sandro Gelsomino designed the study, supervised its steps, and substantially revised the final version of the manuscript.


Supplementary Material



Publication History

Received: 13 July 2020

Accepted: 04 January 2021

Publication Date:
24 February 2021 (online)

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