Is There Really a Benefit of Using Minimized Cardiopulmonary Bypass in CABG? A Retrospective Propensity Score-matched Study with 5000 Cases

Overview

Journal Heart Vessels

Specialty Cardiology & Vascular Diseases

Date 2019 Jun 26

PMID 31236675

Citations 1

Authors

Zdenek Provaznik

Florian Zeman

Daniele Camboni

Marcus Creutzenberg

Christoph Unterbuchner

Alois Philipp

Maik Foltan

Christof Schmid

Bernhard Floerchinger

Affiliations

Soon will be listed here.

Abstract

The concept of minimized cardiopulmonary bypass targets at reduction of adverse effects triggered by extracorporeal circulation. In this study, benefits of minimized bypass in CABG were evaluated under particular consideration of patient body mass index and surgeon impact. From 2004 to 2014, 5164 patients underwent coronary bypass surgery (CABG). Conventional cardiopulmonary bypass (CCPB) was used in 2376 patients, minimized cardiopulmonary bypass (MCPB) in 2788 cases. Multivariate regression models were used in the entire cohort and in a propensity score-matched subgroup after expert CABG to figure out clinical differences such as mortality, postoperative renal function, and thromboembolic events. Overall mortality was 1.5% (n = 41) in the MCPB group and 3.5% (n = 82) in CCPB patients (p < 0.001). Postoperative renal failure and hemodialysis occurred in 2.6% (n = 72/MCPB) vs. 5.3% (n = 122/CCPB (p < 0.001). Multivariable regression revealed use of CCPB as risk factor for increased mortality (OR 2.01, p = 0.001), renal failure (OR 1.79, p < 0.001), and myocardial infarction (OR 1.98, p < 0.001) comparable to risk factors such as preoperative ventilation (OR 2.26, p = 0.048), diabetes mellitus (OR 1.68, p = 0.001), and cardiogenic shock (OR 3.81, p = 0.002). Body mass index had no effect on the analyzed outcome parameters (OR 0.92, p = 0.002). Propensity score-matching analysis of an expert CABG subgroup revealed CCPB as risk factor for mortality (OR 2.26, p = 0.004) and postoperative hemodialysis (OR 1.74, p = 0.017). Compared to conventional circuits, minimized bypass use in CABG is associated with lower mortality and less postoperative renal failure. A high body mass index is feasible and not a risk factor for MCPB surgery.

Citing Articles

Comparative effects of off-pump and multiple cardiopulmonary bypass strategies in coronary artery bypass grafting surgery: protocol for a systematic review and network meta-analysis.

Tan J, Gao S, Li Y, Li X, Du L, Ji B BMJ Open. 2023; 13(6):e072545.

PMID: 37280019 PMC: 10254810. DOI: 10.1136/bmjopen-2023-072545.

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