Korean J Thorac Cardiovasc Surg.  2017 Oct;50(5):355-362. 10.5090/kjtcs.2017.50.5.355.

Risk Factors of On-Pump Conversion during Off-Pump Coronary Artery Bypass Graft

• Yoon SS
• Bang JH
• Jeong SS
• Jeong JH
• Woo JS

• KMID: 2398391
• DOI: http://doi.org/10.5090/kjtcs.2017.50.5.355

Abstract

BACKGROUND
Off-pump coronary artery bypass grafting (OPCABG) procedures can avoid the complications of an on-pump bypass. However, some cases unexpectedly require conversion to cardiopulmonary bypass during OPCABG. The risk factors associated with a sudden need for cardiopulmonary bypass were analyzed.
METHODS
This retrospective study included 283 subjects scheduled for OPCABG from 2001 to 2010. These were divided into an OPCABG group and an on-pump conversion group. Preoperative, operative, and postoperative variables were compared between the 2 groups.
RESULTS
Of the 283 patients scheduled for OPCABG, 47 (16%) were switched to on-pump coronary artery bypass grafting (CABG). The mortality of the both the OPCABG and on-pump conversion groups was not significantly different. The major risk factors for conversion to on-pump CABG were congestive heart failure (CHF) (odds ratio [OR], 3.5; p=0.029), ejection fraction (EF) <35% (OR, 4.4; p=0.012), and preoperative beta-blocker (BB) administration (OR, 0.3; p=0.007). The use of intraoperative (p=0.007) and postoperative (p=0.021) inotropics was significantly higher in the conversion group. The amount of postoperative drainage (p<0.001) and transfusion (p<0.001) also was significantly higher in the conversion group. There were no significant differences in stroke or cardiovascular complications between the groups over the course of short-term and long-term follow-up.
CONCLUSION
Patients who undergo OPCABG and have CHF or a lower EF (<35%) are more likely to undergo on-pump conversion, while preoperative BB administration could help prevent conversions from OPCABG to on-pump CABG.

Keyword

Off-pump coronary artery bypass grafting; Coronary artery bypass; Myocardial ischemia; Hemodynamic instability; On pump conversion

MeSH Terms

Cardiopulmonary Bypass
Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump*
Drainage
Follow-Up Studies
Heart Failure
Humans
Mortality
Myocardial Ischemia
Retrospective Studies
Risk Factors*
Stroke
Transplants*