Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Risk Factors of On-Pump Conversion during Off-Pump Coronary Artery Bypass Graft

  • Yoon, Sung Sil (Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine) ;
  • Bang, Jung Hee (Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine) ;
  • Jeong, Sang Seok (Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine) ;
  • Jeong, Jae Hwa (Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine) ;
  • Woo, Jong Soo (Department of Thoracic and Cardiovascular Surgery, BHS Hanseo Hospital)
  • Received : 2016.11.02
  • Accepted : 2016.12.30
  • Published : 2017.10.05
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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.

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References

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