HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): George Palmer Syma L. Prince Mitchell J. Magee Phillip Brown Marc Katz Michael J. Mack Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Palmer, G. Articles by Mack, M. J. Search for Related Content PubMed PubMed Citation Articles by Palmer, G. Articles by Mack, M. J. Related Collections Coronary disease

Ann Thorac Surg 2007;83:986-992
© 2007 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Coronary Artery Revascularization (CARE) Registry: An Observational Study of On-Pump and Off-Pump Coronary Artery Revascularization

^a Central Florida Regional Hospital, Sanford, Florida
^b Medical City Dallas Hospital, Dallas, Texas
^c HCA Cardiovascular Care Management Network, Nashville, Tennessee
^d Cardiopulmonary Research Science and Technology Institute, Dallas, Texas

Accepted for publication October 23, 2006.

^_* Address correspondence to Syma L. Prince, RN, Cardiopulmonary Research Science and Technology Institute (CRSTI), 7777 Forest Lane, Ste C-742, Dallas, TX 75230 (Email: sprince{at}crsti.org).

Presented at the Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.

Background: The Coronary Artery Revascularization (CARE) study is a multicenter observational registry of coronary revascularization by percutaneous and surgical techniques. As a substudy of this registry, we analyzed the current practice and outcomes of on-pump and off-pump coronary artery bypass graft (CABG) surgery.

Methods: Procedural and outcomes data were prospectively collected for all patients undergoing isolated CABG in eight community-based hospitals in the HCA Hospital System between February 1 and July 31, 2004. Twelve-month follow-up was obtained by patient contact, phone, questionnaire, and the National Death Index.

Results: Isolated coronary artery revascularization procedures were done in 1251 patients, with 12-month follow-up data available on 1149 (91.8%); 654 patients (52.3%) were operated on-pump and 597 (47.7%) had off-pump procedures. On-pump versus off-pump results were mean number of grafts, 3.4 ± 1 versus 2.9 ± 1.2 (p < 0.001); operative mortality, 1.7% versus 1.7% (p = 1.00); permanent stroke, 0.9% versus 0.7% (p = 0.51); reoperation for bleeding, 2.6% versus 1.0% (p = 0.037); prolonged ventilation, 10.0% versus 3.4% (p < 0.001); atrial fibrillation, 23.8% versus 14.9% (p < 0.001); need for transfusion, 51.0% versus 34.9% (p < 0.001); intensive care unit length of stay, 68.1 ± 97.0 hours versus 59.3 ± 109.4 hours (p = 0.16); and hospital length of stay, 7.5 days versus 6.2 days (p < 0.001). At 12 months, there was no difference in total cardiac mortality on-pump versus off-pump (4.9% versus 4.6%, p = 0.88), myocardial infarction (1.0% versus 0.7%, p = 0.76), need for repeat revascularization (2.8% versus 4.1%, p = 0.70), or total overall major adverse cardiac outcomes (8.7 versus 9.4, p = 0.69).

Conclusions: Current approaches to coronary revascularization using both on-pump and off-pump techniques at individual surgeon discretion, which varies significantly in the community setting, leads to acceptable outcomes. Although perioperative complications were less off-pump, mortality was the same, both in the perioperative period and at 12 months. Fewer grafts in the off-pump group appeared to be related to disease burden and not incomplete revascularization. Cardiac death, myocardial infarction, and the need for repeat revascularization were equal at 12 months.

This article has been cited by other articles:

				J. D. Puskas, V. H. Thourani, P. Kilgo, W. Cooper, T. Vassiliades, J. D. Vega, C. Morris, E. Chen, B. J. Schmotzer, R. A. Guyton, et al. Off-pump coronary artery bypass disproportionately benefits high-risk patients. Ann. Thorac. Surg., October 1, 2009; 88(4): 1142 - 1147. [Abstract] [Full Text] [PDF]

				V Venugopal, D J Hausenloy, A Ludman, C Di Salvo, S Kolvekar, J Yap, D Lawrence, J Bognolo, and D M Yellon Remote ischaemic preconditioning reduces myocardial injury in patients undergoing cardiac surgery with cold-blood cardioplegia: a randomised controlled trial Heart, October 1, 2009; 95(19): 1567 - 1571. [Abstract] [Full Text] [PDF]

				X. Sun, R. M. Lim, P. C Hill, E. Haile, P. J Corso, and J. M Garcia Current Practice and Outcomes of Off-pump Multivessel Coronary Artery Bypass Asian Cardiovasc Thorac Ann, August 1, 2009; 17(4): 362 - 367. [Abstract] [Full Text] [PDF]

				M. J. Magee, E. Hebert, M. A. Herbert, S. L. Prince, T. M. Dewey, D. V. Culica, and M. J. Mack Fewer Grafts Performed in Off-Pump Bypass Surgery: Patient Selection or Incomplete Revascularization? Ann. Thorac. Surg., April 1, 2009; 87(4): 1113 - 1118. [Abstract] [Full Text] [PDF]

				J. D. Puskas, P. D. Kilgo, O. M. Lattouf, V. H. Thourani, W. A. Cooper, T. A. Vassiliades, E. P. Chen, J. D. Vega, and R. A. Guyton Off-Pump Coronary Bypass Provides Reduced Mortality and Morbidity and Equivalent 10-Year Survival Ann. Thorac. Surg., October 1, 2008; 86(4): 1139 - 1146. [Abstract] [Full Text] [PDF]

				S. F. Marasco, L. N. Sharwood, and M. J. Abramson No improvement in neurocognitive outcomes after off-pump versus on-pump coronary revascularisation: a meta-analysis Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 961 - 970. [Abstract] [Full Text] [PDF]