Abstract
BackgroundWe retrospectively assessed the outcomes after coronary revascularization at a single Veterans Affairs Medical Center when a strategy of assigning higher risk patients to off-pump coronary artery bypass grafting (CABG) was employed.MethodsOver a 5 year period all consecutive patients that underwent CABG at our VA Medical Center were assigned to a surgeon who either performs the CABG exclusively off-pump or to one who performed the CABG on-pump. The higher risk patients were assigned preferentially for off-pump revascularization. VASQIP (VA Hospitals Surgical Quality Improvement Program) data between 10/2007 and 12/2012 were retrospectively reviewed at our VA Medical Center and the short term outcomes were assessed.ResultsA total of 252 consecutive patients underwent off-pump CABG (n = 170) and on-pump CABG (n = 82). There were significantly more patients with low LVEF (<45 %; p = 0.008) and cerebrovascular disease in the off-pump group (p = 0.024). The number of patients smoking at the time of surgery was significantly higher in the off-pump group (p = 0.002) as well. The 30-day composite morbidity and mortality was 6 % for all CABG patients and significantly lower with off-pump vs. on-pump CABG (3.5 % vs. 11 %; p = 0.019). There were no conversions from off-pump to on-pump surgery.ConclusionsA selective strategy to direct higher risk patients towards an off-pump revascularization yielded favorable outcomes in an unselected veteran population treated at a single VA Medical Center over a 5 year period.
Highlights
We retrospectively assessed the outcomes after coronary revascularization at a single Veterans Affairs Medical Center when a strategy of assigning higher risk patients to off-pump coronary artery bypass grafting (CABG) was employed
We retrospectively studied patients that underwent a CABG procedure at our Veterans Affairs (VA) Hospital, between October
There was no significant difference between off-pump CABG and on-pump CABG in the rate of 30-day composite outcome and the rate of 1-year composite outcome was even higher for off-pump CABG than on-pump CABG
Summary
We retrospectively assessed the outcomes after coronary revascularization at a single Veterans Affairs Medical Center when a strategy of assigning higher risk patients to off-pump coronary artery bypass grafting (CABG) was employed. There are numerous studies that show benefits with the off-pump revascularization in low as well as high risk patients [1,2,3,4,5] The former showed shorter intensive care unit (ICU) and hospital stay, shorter ventilation time, decreased rate of atrial fibrillation, transfusion, inotrope requirements, respiratory infections, stroke, delirium, and postoperative. The purpose of the present study was to compare short-term outcomes (mortality and complications) for all consecutive patients undergoing CABG surgery at our Veterans Affairs (VA) center from 2007 to 2012. Over this five year period, we have used a selective approach in directing higher risk patients towards off-pump coronary artery bypass surgery with the aim of improving overall outcomes
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