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Ann Thorac Surg 2005;80:136-142
© 2005 The Society of Thoracic Surgeons
a Department of Cardiothoracic Surgery, The Cardiothoracic Centre, Liverpool, United Kingdom
b Department of Research and Development, The Cardiothoracic Centre, Liverpool, United Kingdom
Accepted for publication February 1, 2005.
* Address reprint requests to Mr Grayson, The Cardiothoracic Centre-Liverpool, Thomas Dr, Liverpool, L14 3PE, UK (Email: tony.grayson{at}ctc.nhs.uk).
BACKGROUND: Recent publications have shown coronary surgery is safe and effective in patients with critical left main stem stenosis when using off-pump coronary surgery techniques. However, these studies were small and did not adjust for differences in case mix.
METHODS: Between April 1997 and March 2003, 1,197 consecutive patients with critical left main stem stenosis (> 50%) underwent coronary surgery. Two hundred and fifty-nine (21.6%) of these patients had off-pump coronary surgery, while 938 (78.4%) received on-pump coronary surgery. Multivariate logistic regression and Cox proportional hazards analysis were used to assess the effect of off-pump coronary surgery on outcomes, while adjusting for patient characteristics (treatment selection bias). Treatment selection bias was controlled by constructing a propensity score from core patient characteristics. The propensity score was the probability of receiving off-pump coronary surgery and was included along with the comparison variable in the multivariable analyses of outcome.
RESULTS: After adjusting for the propensity score, the requirement for inotropic support (22.4% versus 35.3%; p < 0.001) or a prolonged length of stay (5.3% versus 9.3%; p = 0.034) were significantly reduced after receiving off-pump coronary surgery. There was a trend to suggest that off-pump patients had a lower incidence of stroke and chest infection. The adjusted freedom from death in off-pump patients at 2 years was 94.6% compared with 93.6% for on-pump patients (p = 0.54).
CONCLUSIONS: After risk adjustment, patients with critical left main stem stenosis can undergo off-pump coronary surgery safely, with results comparable with on-pump coronary surgery.
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Ann. Thorac. Surg. 2005 80: 142-143.
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