Tailoring Operations to the Patient Is Always Best
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Article, see p 1209
In this issue of Circulation, Kirmani and colleagues1 report the early and late outcomes of >13 000 patients who underwent either on- or off-pump coronary artery bypass grafting (CABG) at a single institution from 2001 to 2015. They found that after propensity matching, these procedures resulted in similar long-term survival and freedom from all-cause mortality and coronary reintervention. However, off-pump surgery patients had shorter hospital stays and fewer perioperative complications, such as myocardial infarction.
The authors are to be congratulated on their excellent observational study and clinical outcomes. During the study, overall hospital mortality after CABG was 2%, stroke <1%, and mediastinitis 0.2%. In addition, the prevalence of conversions from off- to on-pump CABG was only 1.6%. This compares favorably to the 3% prevalence reported in the Society of Thoracic Surgeons Adult Cardiac Surgery Database.2 These excellent clinical outcomes and few conversions are a testament to the fine skill and vast experience of the surgical teams involved in this study.
However, before we conclude from this study that off-pump CABG is as good, if not better, than on-pump CABG, it is important to review the study’s strengths and weaknesses, as well as, others’ findings. This report is an observational study; despite propensity matching, it appears to have important confounders. Surgeons in the study preferred almost exclusively on- or off-pump CABG. The authors point out that, …