Coronary artery bypass grafting without cardiopulmonary bypass-an attractive alternative in high risk patients

Jacob Bergsland, Saira Hasnan, A. Norman Lewin, Joginder Bhayana, Thomas Z. Lajos, Tomas Salerno

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Objective: This study compares preoperative risk factors, estimated, observed, and risk adjusted mortality, and postoperative complications in patients undergoing coronary artery bypass grafting. Patients were divided in two groups depending on operative method: Group A patients had coronary artery bypass grafting using cardiopulmonary bypass. In group B cardiopulmonary bypass was not utilized. Patients operated on between January 1 1995 and August 31 1996 were compared. Group A consisted of 1829 patients and Group B 172. Methods: Patients were selected to undergo coronary artery bypass grafting without the use of cardiopulmonary bypass either because the surgeon felt that there were contraindications to-or no need for the heart- lung machine. The decision to avoid the use of cardiopulmonary bypass was taken pre-operatively by the individual surgeon. Median sternotomy, formal left thoracotomy or left anterior small thoracotomy were used. The data was collected and validated by the hospital's professional data collectors. Data- analysis was performed using the NY-state database. Results: Previous heart surgery and extensively calcified ascending aorta were significantly more common in Group B as was estimated and observed mortality. This resulted in identical risk-adjusted mortality of 2.8%. When reoperations were reviewed separately risk adjusted mortality was lower in Group B (2.1 versus 3.1%) but this difference was not statistically significant. Cardiovascular- and other- complications were higher in group A patients. In reoperative patients this difference was significant (P = 0.05). The need for postoperative mechanical assistance was also reduced (Group A: 14.9% versus Group B: 1.3% P = 0.01). Conclusion: We conclude that coronary artery bypass surgery can be done safely in selected patients without cardiopulmonary bypass. Mortality is unchanged and complications are less frequent. Cost and hospital utilization are decreased. The greatest benefit is observed in reoperations.

Original languageEnglish
Pages (from-to)876-880
Number of pages5
JournalEuropean Journal of Cardio-thoracic Surgery
Volume11
Issue number5
DOIs
StatePublished - Jul 3 1997
Externally publishedYes

Fingerprint

Cardiopulmonary Bypass
Coronary Artery Bypass
Mortality
Thoracotomy
Reoperation
Heart-Lung Machine
Sternotomy
Hospital Costs
Thoracic Surgery
Aorta
Databases

Keywords

  • Cardiopulmonary bypass
  • Complication
  • Coronary artery bypass
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Coronary artery bypass grafting without cardiopulmonary bypass-an attractive alternative in high risk patients. / Bergsland, Jacob; Hasnan, Saira; Lewin, A. Norman; Bhayana, Joginder; Lajos, Thomas Z.; Salerno, Tomas.

In: European Journal of Cardio-thoracic Surgery, Vol. 11, No. 5, 03.07.1997, p. 876-880.

Research output: Contribution to journalArticle

Bergsland, Jacob ; Hasnan, Saira ; Lewin, A. Norman ; Bhayana, Joginder ; Lajos, Thomas Z. ; Salerno, Tomas. / Coronary artery bypass grafting without cardiopulmonary bypass-an attractive alternative in high risk patients. In: European Journal of Cardio-thoracic Surgery. 1997 ; Vol. 11, No. 5. pp. 876-880.
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AB - Objective: This study compares preoperative risk factors, estimated, observed, and risk adjusted mortality, and postoperative complications in patients undergoing coronary artery bypass grafting. Patients were divided in two groups depending on operative method: Group A patients had coronary artery bypass grafting using cardiopulmonary bypass. In group B cardiopulmonary bypass was not utilized. Patients operated on between January 1 1995 and August 31 1996 were compared. Group A consisted of 1829 patients and Group B 172. Methods: Patients were selected to undergo coronary artery bypass grafting without the use of cardiopulmonary bypass either because the surgeon felt that there were contraindications to-or no need for the heart- lung machine. The decision to avoid the use of cardiopulmonary bypass was taken pre-operatively by the individual surgeon. Median sternotomy, formal left thoracotomy or left anterior small thoracotomy were used. The data was collected and validated by the hospital's professional data collectors. Data- analysis was performed using the NY-state database. Results: Previous heart surgery and extensively calcified ascending aorta were significantly more common in Group B as was estimated and observed mortality. This resulted in identical risk-adjusted mortality of 2.8%. When reoperations were reviewed separately risk adjusted mortality was lower in Group B (2.1 versus 3.1%) but this difference was not statistically significant. Cardiovascular- and other- complications were higher in group A patients. In reoperative patients this difference was significant (P = 0.05). The need for postoperative mechanical assistance was also reduced (Group A: 14.9% versus Group B: 1.3% P = 0.01). Conclusion: We conclude that coronary artery bypass surgery can be done safely in selected patients without cardiopulmonary bypass. Mortality is unchanged and complications are less frequent. Cost and hospital utilization are decreased. The greatest benefit is observed in reoperations.

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