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Ann Thorac Surg 2008;86:1139-1146. doi:10.1016/j.athoracsur.2008.05.073
© 2008 The Society of Thoracic Surgeons
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Right arrow Author home page(s):
John D. Puskas
Omar M. Lattouf
Vinod H. Thourani
William A. Cooper
Thomas A. Vassiliades
Edward P. Chen
J. David Vega
Robert A. Guyton
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Right arrow Coronary disease

Original Articles: Adult Cardiac

Off-Pump Coronary Bypass Provides Reduced Mortality and Morbidity and Equivalent 10-Year Survival

John D. Puskas, MDa,*, Patrick D. Kilgo, MSb, Omar M. Lattouf, MDa, Vinod H. Thourani, MDa, William A. Cooper, MDa, Thomas A. Vassiliades, MDa, Edward P. Chen, MDa, J. David Vega, MDa, Robert A. Guyton, MDb

a Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
b Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia

Accepted for publication May 28, 2008.

* Address correspondence to Dr Puskas, Emory University School of Medicine, 6th Floor Medical Office Tower, Emory Crawford Long Hospital, 550 Peachtree St NE, Atlanta, GA 30308 (Email: john.puskas{at}emoryhealthcare.org).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: This study compared in-hospital major adverse cardiac events (MACE) and long-term survival after off-pump (OPCAB) vs on-pump (CPB) coronary artery bypass grafting (CABG).

Methods: Reviewed were 12,812 consecutive isolated CABG patients from 1997 to 2006. A propensity score (PS), including 40 preoperative risk factors, balanced characteristics between OPCAB and CPB groups. Multiple logistic regression models tested whether gender or surgery type, or their interaction, were associated with in-hospital mortality and MACE. A proportional hazards regression model and Kaplan-Meier curves related long-term survival with gender, surgery type, and their interaction, adjusted for PS and age.

Results: OPCAB was associated with a significant reduction in operative mortality (adjusted odds ratio [AOR], 0.68; p = 0.045), stroke (AOR, 0.48; p < 0.001), and MACE (AOR, 0.66; p = 0.018). Female gender was associated with higher rates of death (AOR, 1.93), stroke (AOR, 1.82), myocardial infarction (AOR, 2.19), and MACE (AOR, 1.97; each p < 0.001). Women disproportionately benefited from OPCAB in operative mortality (p = 0.04). Odds of death for women on CPB were higher than for women treated with OPCAB (AOR, 2.07, p = 0.005). Odds of death for men on CPB were not significantly higher than for men treated with OPCAB (AOR, 1.16, p = 0.51). Male gender was associated with longer-term survival (p = .011), but surgery type (OPCAB vs CPB) was not (p = 0.23).

Conclusions: OPCAB provides significant early mortality and morbidity advantages, especially for women. During the 10-year follow-up, OPCAB and CPB result in similar survival, regardless of gender.




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