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Antony D. Grayson
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Walid C. Dihmis
Brian M. Fabri
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Interactive Cardiovascular and Thoracic Surgery 2:660-664(2003)
© 2003 European Association of Cardio-Thoracic Surgery

Institutional review - Coronary

Is off-pump coronary surgery justified in EuroSCORE high-risk cases? A propensity score analysis

Aung Y. Ooa, Antony D. Graysonb, Nirav C. Patela, D. Mark Pullana, Walid C. Dihmisa and Brian M. Fabria,*

a Department of Cardiothoracic Surgery, The Cardiothoracic Centre, Thomas Drive, Liverpool, L14 3PE, UK
b Department of Clinical Governance, The Cardiothoracic Centre, Thomas Drive, Liverpool, L14 3PE, UK

* Corresponding author. Tel.: +44-151-293-2397; fax: +44-151-220-8573
brian.fabri{at}ctc.nhs.uk

We aimed to quantify the effect of avoiding cardiopulmonary bypass on outcomes in high-risk patients. Of the 2079 consecutive CABG's performed by three surgeons between April 1997 and September 2002, 389 were classified as high-risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification, with a score of >5. The off-pump group had 196 patients and the on-pump group had 193 patients. Multivariate logistic regression was used to assess the effect of off-pump on in-hospital outcomes, while adjusting for treatment selection bias with a propensity score. The incidence of hypertension, hypercholesterolaemia, and renal dysfunction were higher in the off-pump group. The median EuroSCORE for off-pump patients was 7 (6–8), while for the on-pump patients was 7 (6–8; ). After adjusting for the propensity score, off-pump patients were less likely to have stroke (OR 0.17; ), renal failure (OR 0.35; ), blood transfusion (OR 0.12; ), prolonged mechanical ventilation (OR 0.36; ), and inotrope support (OR 0.35; ). Off-pump patients also had significantly shorter post-operative hospital stays. There was no significant difference between off-pump and on-pump patients in terms of in-hospital and mid-term mortality. Off-pump CABG is justified in EuroSCORE high-risk cases.

Key Words: Off-pump coronary artery bypass surgery; Morbidity; Mortality; EuroSCORE; High-risk patients; Propensity score




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