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To CBP or not to CBP: Which patients greater benefit from an off-pump CABG strategy?
Session:
Painel 11 -Cardiologia Intervenção 1
Speaker:
Pedro Lamares Magro
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.1 Cardiovascular Surgery – Coronary Arteries
Session Type:
Posters
FP Number:
---
Authors:
Pedro Lamares Magro; Miguel Sousa Uva; José Pedro Neves
Abstract
<p><strong>Introduction </strong></p> <p>Over the past 3 decades the main strategy for surgical coronary revascularization has been on-pump CABG with cardioplegic cardiac arrest. Off-pump CABG achieved great popularity in the 90’s rising interest both by evicting CPB associated complications and cost. However, despite the large volume of evidence generated around both strategies, studies fail to demonstrate clear benefit of either strategy regarding mortality and most common complications. The objective of this study is to evaluate the long-term survival impact of off and on-pump strategies in all patients subject to isolated CABG in our institution, as well as specific risk groups. </p> <p><strong>Methods </strong></p> <p>This study consists of a retrospective single-centre intention to treat analysis including 843 consecutive isolated CABG patients with a minimum follow-up of 10 years. A propensity score matched analysis regarding age, CCS class, number of affected coronary territories, left main disease, complete revascularization, recent and previous AMI, impaired ejection fraction, previous cardiac surgery, diabetes mellitus, arterial hypertension, previous stroke, estimated glomerular filtration rate, urgent surgery, gender and only arterial grafts used; was conducted with a caliper of 0.025 and a 1:1 ratio. Two equally distributed groups (OFF- PUMP N= 246 and ON-PUMP n =246) without statistically different characteristics were then compared using Kaplan-Meier analysis for the overall group and the following specific groups: Males; females; Diabetic patients; Elderly (>80 years old); eGFR<30 mL/min/1.73 m<sup>2</sup>; previous stroke; previous AMI; EF<30%; 2 territories/vessel disease; 3 territory/vessel disease; LM disease; patients in which only arterial grafts were used; complete and incomplete revascularization; size of main vessel and time from acute myocardial infarction. </p> <p><strong>Results </strong></p> <p>No difference in overall 30-days mortality an long-term survival (minimum follow-up of 10 years). Sub-group analysis showed no difference between the groups evaluated for long-term mortality except for the subgroup of patients operated between 8-21 days after acute myocardial infarction (mean survival time: 9 years in OFF-PUMP grouop <em>vs</em> 11 years in ON-PUMP group; p=0.03). </p> <p><strong>Discussion</strong></p> <p>Our results are similar of those found in the literature as neither strategy has unequivocal superior results. Certain subgroups of patients have been proposed to benefit from an off-pump strategy (chronic renal disease; severely impaired ejection fraction, recent AMI). In our analysis patients with recent AMI (but not in the first 7 days) seem to benefit from an off-pump strategy regarding long-term mortality. </p> <p>Major limitations include: analysis not matched for surgeon performance; cardiac related events, re-revascularization need and graft patency not evaluated, as well as other major morbidity causes. </p> <p> </p>
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