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KMID : 0364020170500050355
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Korean Journal of Thoracic and Cardiovascular Surgery
2017 Volume.50 No. 5 p.355 ~ p.362
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Risk Factors of On-Pump Conversion during Off-Pump Coronary Artery Bypass Graft
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Yoon Sung-Sil
Bang Jung-Hee
Jeong Sang-Seok
Jeong Jae-Hwa
Woo Jong-Soo
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Abstract
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Background: Off-pump coronary artery bypass grafting (OPCABG) procedures can avoid the complications of an o n-pump b ypass. However, some c ases u nexpectedly require c onversion to c ardiopulmonary b ypass 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.
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KEYWORD
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Off-pump coronary artery bypass grafting, Coronary artery bypass, Myocardial ischemia, Hemodynamic instability, On pump c onversion
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