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(Circulation. 2007;116:1756-1758.)
© 2007 American Heart Association, Inc.

Editorial

Would You Like Some Cardiopulmonary Bypass With Your Coronary Revascularization?

John D. Puskas, MD; Mark Steele, CCP, CCT

From Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.

Correspondence to John D. Puskas, MD, Professor of Surgery, Associate Chief, Cardiothoracic Surgery, 550 Peachtree St, NE, 6th Floor Medical Office Tower, Atlanta, GA 30308. E-mail john.puskas@emoryhealthcare.org

Key Words: Editorials • coronary artery bypass • cardiopulmonary bypass

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In an effort to reduce morbidity and mortality attributable to cardiopulmonary bypass (CPB),¹ US surgeons performed 20% of all coronary artery bypass (CAB) operations off-pump, without the use of CPB, in 2006.² These surgeons were guided by several retrospective reviews of large databases that have shown off-pump CAB (OPCAB) is associated with lower risk-adjusted morbidity and mortality than coronary artery bypass grafting (CABG) on CPB (ONCAB).^3–5 In 2004, the Society of Thoracic Surgeons, National Adult Cardiac Database added a data field to record intraoperative conversions, which permits the comparison of outcomes after OPCAB and ONCAB by intention-to-treat. In the first subsequent analysis of the Society of Thoracic Surgeons National Adult Cardiac Database,⁶ preoperative risk factors and postoperative outcomes were analyzed for 42 477 consecutive patients who underwent non-emergent, isolated, primary CAB surgery from January 1, 2004, through December 31, 2005. OPCAB was associated with a significantly reduced risk-adjusted incidence of death (odds ratio [OR], 0.83; P=0.03), stroke (OR, 0.65; P<0.001), myocardial infarction (OR, 0.67; P<0.001), major adverse cardiac events (OR, 0.71; P<0.001), renal failure (OR, 0.74; P<0.001), new dialysis (OR, 0.63; P<0.001), deep sternal wound infection (OR, 0.67; P=0.04), reoperation (OR, 0.86; P=0.004), atrial fibrillation (OR, 0.88; P<0.001), prolonged ventilation (OR, 0.75; P<0.001), and prolonged length of stay (OR, 0.70; P<0.001) compared with ONCAB. A recent retrospective review of risk factors and clinical outcomes for 11 413 consecutive patients who underwent isolated CABG between January 1, 1997, and May . . . [Full Text of this Article]

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