Background
Coronary artery bypass grafting (CABG) performed early after acute myocardial infarction
(AMI) carries a high risk of mortality. By avoiding cardioplegic arrest and aortic
cross-clamping, on-pump beating heart CABG (ONBEAT) may benefit patients requiring
urgent or emergency revascularisation in the setting of AMI. We evaluated the early
and long-term outcomes of ONBEAT versus conventional CABG (ONSTOP) utilising the ANZSCTS
National Cardiac Surgery Database.
Methods
Between 2001 and 2015, 5,851 patients underwent non-elective on-pump CABG within 7
days of AMI. Of these, 77 patients (1.3%) underwent ONBEAT and 5774 (98.7%) underwent
ONSTOP surgery. Propensity-score matching (with a 1:2 matching ratio) was performed
for risk adjustment. Survival data were obtained from the National Death Index.
Results
Before matching, the unadjusted 30-day mortality was ONBEAT: 9/77 (11.7%) vs. ONSTOP:
256/5,774 (4.4%), p< 0.001. Preoperative factors independently associated with the ONBEAT were: septuagenarian
age, peripheral vascular disease, redo surgery, cardiogenic shock, emergency surgery
and single-vessel disease. After propensity-score matching, 30-day mortality was similar
(ONBEAT: 9/77 (11.7%) vs. ONSTOP: 16/154 (10.4%), p = 0.85), as was the rate of major adverse cardiac and cerebrovascular events (ONBEAT:
17/77 (22.1%) vs. ONSTOP: 38/154 (24.7%), p = 0.84). ONBEAT patients received fewer distal anastomoses and were more likely to have
incomplete revascularisation (ONBEAT: 15/77 (19.5%) vs. ONSTOP: 15/154, (9.7%), p = 0.03). Despite this, 12-year survival was comparable (ONBEAT: 64.8% (95% CI 39.4-82.4%)
vs. ONSTOP: 63.6% (95% CI 50.5, 74.3%), p = 0.89).
Conclusions
ONBEAT can be performed safely in high-risk patients requiring CABG early after AMI
with similar short and long-term survival compared to ONSTOP.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 2014 ESC/EACTS Guidelines on myocardial revascularization.Eur Heart J. 2014; 35: 2541-2619
- 2011 ACCF/AHA guidelines for coronary artery bypass graft surgery.Circulation. 2011; 124: e652-e735
- The effect of orotic acid on the response of the recently infarcted rat heart to hypothermic cardioplegia.Eur J Cardiothorac Surg. 1991; 5 (discussion 3): 82-92
- Sensitivity of the recently infarcted heart to cardioplegic arrest: Beneficial effect of pretreatment with orotic acid.J Thorac Cardiovasc Surg. 1989; 97: 593-604
- Intra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis.Eur J Cardiothorac Surg. 2012; 41: 291-299
- Worse long-term survival after off-pump than on-pump coronary artery bypass grafting.J Thorac Cardiovasc Surg. 2014; 148: 1820-1829
- On-pump beating-heart coronary artery bypass: a propensity matched analysis.Ann Thorac Surg. 2007; 83: 1368-1373
- On-pump beating-heart versus conventional coronary artery bypass grafting for revascularization in patients with severe left ventricular dysfunction: early outcomes.Can J Surg. 2013; 56: 398-404
- On-pump beating-heart coronary artery bypass grafting after acute myocardial infarction has lower mortality and morbidity.J Thorac Cardiovasc Surg. 2008; 135: 521-526
- On-pump beating-heart coronary artery bypass provides efficacious short- and long-term outcomes in hemodialysis patients.Nephrol Dial Transplant. 2012; 27: 2059-2065
- On-pump beating-heart coronary artery bypass grafting for acute myocardial infarction.Ann Thorac Surg. 2006; 81: 573-576
- Does on-pump/beating-heart coronary artery bypass grafting offer better outcome in end-stage coronary artery disease patients?.J Card Surg. 2000; 15: 403-410
- On-pump beating-heart technique is associated with lower morbidity and mortality following coronary artery bypass grafting: a meta-analysis.Eur J Cardiothorac Surg. 2016; https://doi.org/10.1093/ejcts/ezw129
- Beating-heart coronary artery bypass surgery with the help of mini extracorporeal circulation for very high-risk patients.Perfusion. 2011; 26: 123-131
- On-pump coronary surgery with and without cardioplegic arrest: comparison of inflammation, myocardial, cerebral and renal injury and early and late health outcome in a single-centre randomised controlled trial.Eur J Cardiothorac Surg. 2011; 39: 675-683
- Beating-heart versus conventional on-pump coronary artery bypass grafting: a meta-analysis of clinical outcomes.Ann Thorac Surg. 2015; 100: 2251-2260
- A randomized control trial of on-pump beating heart and conventional cardiologic arrest in coronary artery bypass surgery patients with impaired left ventricular function using cardiac magnetic resonance imaging and biochemical markers.Circulation. 2008; 118: 2130-2138
- Trends in coronary artery bypass graft surgery in Victoria, 2001–2006: findings from the Australasian Society of Cardiac and Thoracic Surgeons database project.Med J Aust. 2008; 188: 214-217
- ANZSCTS National Cardiac Surgery Database Program: Data Definitions Manual, v3.Dept. Epidemiology & Preventive Medicine, Monash University, Melbourne, AUS2011
- The role of the c-statistic in variable selection for propensity score models.Pharmacoepidemiol Drug Saf. 2011; 20: 317-320
- Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement.J Thorac Cardiovasc Surg. 2007; 134: 1128-1135
- Nonparametric statistics for healthcare research: statistics for small samples and unusual distributions.1st ed. SAGE Publications, Thousand Oaks, CA, USA1997
- Survival analysis: techniques for censored and truncated data.Springer-Verlag, New York1997
- Biochemical changes in non-infarcted heart muscle following myocardial infarction.J Mol Cell Cardiol. 1971; 2: 253-276
- Changes in noninfarcted myocardium explain benefits of on-pump beating-heart coronary artery bypass grafting for acute myocardial infarction.J Thorac Cardiovasc Surg. 2009; 137: 1575-1576
- On-pump beating heart surgery.Heart Lung Circ. 2011; 20: 295-304
- On-pump, beating-heart coronary artery operations in high-risk patients: an acceptable trade-off?.Ann Thorac Surg. 1997; 64: 1368-1373
- Thoracic and cardiovascular surgery in Japan during 2014: Annual report by The Japanese Association for Thoracic Surgery.Gen Thorac Cardiovasc Surg. 2016; 64: 665-697
- On-pump beating heart surgery offers an alternative for unstable patients undergoing coronary artery bypass grafting.Heart Surg Forum. 2004; 7: 8-15
- Methods for constructing and assessing propensity scores.Health Serv Res. 2014; 49: 1701-1720
Article info
Publication history
Published online: July 10, 2018
Accepted:
June 25,
2018
Received:
March 13,
2018
Identification
Copyright
© 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- On and Off Pump: The Marriage of Opposites With Potential Long-Term RewardsHeart, Lung and CirculationVol. 28Issue 8
- PreviewThere are at least three different methods of surgical coronary revascularisation—on-pump with an arrested heart, on-pump without arrest of the heart, and off-pump surgery. The on-pump beating (ONBEAT) coronary bypass surgery embodies an amalgamation of conventional on-pump coronary surgery (CABG) and off-pump technique (OPCAB). The principal benefits emerging from the ONBEAT technique are the avoidance of cardioplegic arrest and the haemodynamic stability ensured throughout the procedure, notably in unstable high-risk patients.
- Full-Text
- Preview
