The Journal of Thoracic and Cardiovascular Surgery
Volume 124, Issue 4 , Pages 698-707 , October 2002

Does off-pump coronary surgery reduce morbidity and mortality?

Read at the Eighty-first Annual Meeting of The American Association for Thoracic Surgery, San Diego, Calif, May 6-9, 2001.

Received 15 May 2001 ,Revised 12 October 2001 ,Accepted 24 October 2001.

References 

  1. Puskas JD, Wright CE, Ronson RS, Brown WM, Gott JP, Guyton RA. Off-pump multivessel coronary bypass via sternotomy is safe and effective. Ann Thorac Surg. 1998;66:1068–1072
  2. Koutlas TC, Elbeery JR, Williams JM, Moran JF, Francalancia NA, Chitwood WR. Myocardial revascularization in the elderly using beating heart coronary artery bypass surgery. Ann Thorac Surg. 2000;69:1042–1047
  3. Yokoyama T, Baumgartner FJ, Gheissari A, Capouya ER, Panagiotides GP, Declusin RJ. Off-pump versus on-pump coronary bypass in high-risk subgroups. Ann Thorac Surg. 2000;70:1546–1550
  4. Iaco AL, Contini M, Teodori G, Di Mauro M, Di Giammarco G, Vitolla G, et al.  Off or on bypass: what is the safety threshold?. Ann Thorac Surg. 1999;68:1486–1489
  5. Calafiore AM, Teodori G, Di Giammarco G, Vitolla G, Maddestra N, Paloscia L, et al.  Multiple arterial conduits without cardiopulmonary bypass: early angiographic results. Ann Thorac Surg. 1999;67:450–456
  6. Buffolo E, Silva de Andrade JC, Rodgrigues Branco JN, Teles CA, Aguiar LF, Gomes WJ. Coronary artery bypass grafting without cardiopulmonary bypass. Ann Thorac Surg. 1996;61:63–66
  7. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70:41–55
  8. D'Agostino RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17:2265–2281
  9. Breiman L. Bagging predictors. Machine Learning. 1996;24:123–140
  10. Baskerville JC, Toogood JH. Guided regression modeling for prediction and exploration of structure with many explanatory variables. Technometrics. 1982;24:9–17
  11. Parsons LS. Reducing bias in propensity score matched-pair sample using greedy matching techniques. In: Proceedings of the Twenty-Sixth Annual SAS Users Group International Conference. Long Beach, Calif. Cary, NC: SAS Institute Inc; 2001;
  12. Contini M, Iaco A, Iovino T, Teodori G, Di Giammarco G, Mazzei V, et al.  Current results in off pump surgery. Eur J Cardiothorac Surg. 1999;16:S69–S72
  13. Bull DA, Neumayer LA, Stringham JC, Meldrum P, Affleck DG, Karwande SV. Coronary artery bypass grafting with cardiopulmonary bypass versus off-pump cardiopulmonary bypass grafting: does eliminating the pump reduce morbidity and cost?. Ann Thorac Surg. 2001;71:170–175
  14. Kshettry VR, Flavin TF, Emery RW, Nicoloff DM, Arom KV, Petersen RJ. Does multivessel, off-pump coronary artery bypass reduce postoperative morbidity?. Ann Thorac Surg. 2000;69:1725–1730
  15. Czemy M, Baumer H, Kilo J, Zuckermann A, Grubhofer G, Chevtchik O, et al.  Complete revascularization in coronary artery bypass grafting with and without cardiopulmonary bypass. Ann Thorac Surg. 2001;71:165–169
  16. Arom KV, Flavin TF, Emery RW, Kshettry VR, Janey PA, Petersen RJ. Safety and efficacy of off-pump coronary artery bypass grafting. Ann Thorac Surg. 2000;69:704–710
  17. Westaby S, Johnsson P, Parry AJ, Blomqvuist S, Solem JO, Ailing C, et al.  Serum S100 protein: a potential marker for cerebral events during cardiopulmonary bypass. Ann Thorac Surg. 1996;61:88–92
  18. Anderson RE, Li TQ, Hindmarch T, Settergren G, Vaage J. Increased extracellular brain water after coronary artery bypass grafting is avoided by off-pump surgery. J Cardiothorac Vasc Anesth. 1999;13:698–702
  19. Lloyd CT, Ascione R, Underwood MJ, Gardner F, Black A, Angelini GD. Serum S-100 protein release and neuropsychologic outcome during coronary revascularization on the beating heart: a prospective randomized study. J Thorac Cardiovasc Surg. 2000;119:148–154
  20. Wandschneider W, Thalmann M, Trampitsch E, Ziervogel G, Kobinia G. Off-pump coronary bypass operations significantly reduce S100 release: an indicator for less cerebral damage?. Ann Thorac Surg. 2000;70:1577–1579
  21. Taggart DP, Browne SM, Halligan PW, Wade DT. Is cardiopulmonary bypass still the cause of cognitive dysfunction after cardiac operations?. J Thorac Cardiovasc Surg. 1999;118:420–421
  22. Vingerhoets G, Jannes C, De Soete G, Van Nooten G. Prospective evaluation of verbal memory performance after cardiopulmonary bypass surgery. J Clin Exp Neuropsychol. 1996;18:187–196
  23. Toner I, Taylor KM, Newman S, Smith PL. Cerebral functional changes following cardiac surgery: neuropsychological and EEG assessment. Eur J Cardiothorac Surg. 1998;13:13–20
  24. Newman MF, Kirchner JL, Phillips-Bute B, Gaver B, Grocott H, Jones RH, et al.  Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001;344:395–402
  25. Ascione R, Williams S, Lloyd CT. Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: a prospective randomized study. J Thorac Cardiovasc Surg. 2001;121:689–696
  26. Kawahito K, Kobayashi E, Iwasa H, Misawa Y, Fuse K. Platelet aggregation during cardiopulmonary bypass evaluated by a laser light-scattering method. Ann Thorac Surg. 1999;69:79–84
  27. Kestin AS, Valeri CR, Khuri SF, Loscalzo J, Ellis PA, MacGregor H, et al.  The platelet function defect of cardiopulmonary bypass. Blood. 1993;82:107–117
  28. Chiu RC, Samson R. Complement (C3, C4) consumption in cardiopulmonary bypass, cardioplegia, and protamine administration. Ann Thorac Surg. 1984;37:229–232
  29. Hamano K, Gohra H, Katoh T, Fujimura Y, Zempo N, Esato K. The preoperative administration of lentinan ameliorated the impairment of natural killer activity after cardiopulmonary bypass. Int J Immunopharmacol. 1999;21:531–540
  30. Scott R, Blackstone EH, McCarthy PM, Lytle BW, Loop FD, White JA, et al.  Isolated bypass grafting of the left internal thoracic artery to the left anterior descending coronary artery: late consequences of incomplete revascularization. J Thorac Cardiovasc Surg. 2000;120:173–184
  31. Bell MR, Gersh BJ, Schaff HV, Holmes DR, Fischer LD, Alderman EL, et al.  Effect of completeness of revascularization on long-term outcome of patients with three-vessel disease undergoing coronary artery bypass surgery: a report from the Coronary Artery Surgery Study (CASS) Registry. Circulation. 1992;86:446–457
  32. Jones EL, Weintraub WS. The importance of completeness of revascularization during long-term follow-up after coronary artery bypass operations. J Thorac Cardiovasc Surg. 1996;112:227–237

 Partial funding of nursing personnel for data collection of the off-pump cases was provided by Guidant Corporation, which otherwise had no input into the analyses and did not review or endorse the results reported in this study.

☆☆ Address for reprints: Joseph F. Sabik, MD, The Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195 (E-mail: sabikj@ccf.org).

PII: S0022-5223(02)00141-1

doi: 10.1067/mtc.2002.121975

The Journal of Thoracic and Cardiovascular Surgery
Volume 124, Issue 4 , Pages 698-707 , October 2002