Off‐Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs’ Use and Outcomes
Background Coronary artery bypass can be performed off pump (OPCAB) without cardiopulmonary bypass. However, trends over time for OPCAB versus on‐pump (ONCAB) use and long‐term outcome has not been reported, nor has their long‐term outcome been compared. Methods and Results We queried the national V...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.023514 |
| _version_ | 1797859013111578624 |
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| author | Salil V. Deo Yakov Elgudin A. Laurie W. Shroyer Salah Altarabsheh Vikas Sharma Joseph Rubelowsky Lorraine Cornwell Piroze Davierwala Danny Chu Brian Cmolik |
| author_facet | Salil V. Deo Yakov Elgudin A. Laurie W. Shroyer Salah Altarabsheh Vikas Sharma Joseph Rubelowsky Lorraine Cornwell Piroze Davierwala Danny Chu Brian Cmolik |
| author_sort | Salil V. Deo |
| collection | DOAJ |
| description | Background Coronary artery bypass can be performed off pump (OPCAB) without cardiopulmonary bypass. However, trends over time for OPCAB versus on‐pump (ONCAB) use and long‐term outcome has not been reported, nor has their long‐term outcome been compared. Methods and Results We queried the national Veterans Affairs database (2005–2019) to identify isolated coronary artery bypass procedures. Procedures were classified as OPCAB on ONCAB using the as‐treated basis. Trend analyses were performed to evaluate longitudinal changes in the preference for OPCAB. The median follow‐up period was 6.6 (3.5–10) years. An inverse probability weighted Cox model was used to compare all‐cause mortality between OPCAB and ONCAB. From 47 685 patients, 6759 (age 64±8 years) received OPCAB (14%). OPCAB usage declined from 16% (2005–2009) to 8% (2015–2019). Patients with triple vessel disease who received OPCAB received a lower mean number of grafts (2.8±0.8 versus 3.2±0.8; P<0.01). The ONCAB 5‐, 10‐, and 15‐year survival rates were 82.9% (82.5–83.3), 60.4% (59.8–61.1), and 37.2% (36.1–38.4); correspondingly, OPCAB rates were 80.7% (79.7–81.7), 57.4% (56–58.7), and 34.1% (31.7–36.6) (P<0.01). OPCAB was associated with increased risk‐adjusted all‐cause mortality (hazard ratio, 1.15 [1.13–1.18]; P<0.01) and myocardial infarction (incident rate ratio, 1.16 [1.05–1.28]; P<0.01). Conclusions Over 15 years, OPCAB use declined considerably in Veterans Affairs medical centers. In Veterans Affairs hospitals, late all‐cause mortality and myocardial infarction rates were higher in the OPCAB cohort. |
| first_indexed | 2024-04-09T21:22:37Z |
| format | Article |
| id | doaj.art-5090400550694698934e1d7d1a0a1243 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T21:22:37Z |
| publishDate | 2022-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-5090400550694698934e1d7d1a0a12432023-03-28T04:20:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-03-0111610.1161/JAHA.121.023514Off‐Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs’ Use and OutcomesSalil V. Deo0Yakov Elgudin1A. Laurie W. Shroyer2Salah Altarabsheh3Vikas Sharma4Joseph Rubelowsky5Lorraine Cornwell6Piroze Davierwala7Danny Chu8Brian Cmolik9Surgical Services Louis Stokes Cleveland VA Medical Center Cleveland OHSurgical Services Louis Stokes Cleveland VA Medical Center Cleveland OHDepartment of Surgery Health Sciences Center Stony Brook Renaissance School of Medicine Stony Brook New YorkDepartment of Cardiac Surgery Queen Alia Heart Institute Amman JordanSurgical Services George E Wahlen VA Medical Center Salt Lake City UTSurgical Services Louis Stokes Cleveland VA Medical Center Cleveland OHMichael E DeBakey VA Medical Center Houston TXDepartment of Cardiac Surgery University of Toronto CanadaDivision of Cardiac Surgery Department of Cardiothoracic Surgery University of Pittsburgh PASurgical Services Louis Stokes Cleveland VA Medical Center Cleveland OHBackground Coronary artery bypass can be performed off pump (OPCAB) without cardiopulmonary bypass. However, trends over time for OPCAB versus on‐pump (ONCAB) use and long‐term outcome has not been reported, nor has their long‐term outcome been compared. Methods and Results We queried the national Veterans Affairs database (2005–2019) to identify isolated coronary artery bypass procedures. Procedures were classified as OPCAB on ONCAB using the as‐treated basis. Trend analyses were performed to evaluate longitudinal changes in the preference for OPCAB. The median follow‐up period was 6.6 (3.5–10) years. An inverse probability weighted Cox model was used to compare all‐cause mortality between OPCAB and ONCAB. From 47 685 patients, 6759 (age 64±8 years) received OPCAB (14%). OPCAB usage declined from 16% (2005–2009) to 8% (2015–2019). Patients with triple vessel disease who received OPCAB received a lower mean number of grafts (2.8±0.8 versus 3.2±0.8; P<0.01). The ONCAB 5‐, 10‐, and 15‐year survival rates were 82.9% (82.5–83.3), 60.4% (59.8–61.1), and 37.2% (36.1–38.4); correspondingly, OPCAB rates were 80.7% (79.7–81.7), 57.4% (56–58.7), and 34.1% (31.7–36.6) (P<0.01). OPCAB was associated with increased risk‐adjusted all‐cause mortality (hazard ratio, 1.15 [1.13–1.18]; P<0.01) and myocardial infarction (incident rate ratio, 1.16 [1.05–1.28]; P<0.01). Conclusions Over 15 years, OPCAB use declined considerably in Veterans Affairs medical centers. In Veterans Affairs hospitals, late all‐cause mortality and myocardial infarction rates were higher in the OPCAB cohort.https://www.ahajournals.org/doi/10.1161/JAHA.121.023514coronary artery bypass graftinglong term survivalmyocardial infarctionoff‐pump surgery |
| spellingShingle | Salil V. Deo Yakov Elgudin A. Laurie W. Shroyer Salah Altarabsheh Vikas Sharma Joseph Rubelowsky Lorraine Cornwell Piroze Davierwala Danny Chu Brian Cmolik Off‐Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs’ Use and Outcomes Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease coronary artery bypass grafting long term survival myocardial infarction off‐pump surgery |
| title | Off‐Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs’ Use and Outcomes |
| title_full | Off‐Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs’ Use and Outcomes |
| title_fullStr | Off‐Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs’ Use and Outcomes |
| title_full_unstemmed | Off‐Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs’ Use and Outcomes |
| title_short | Off‐Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs’ Use and Outcomes |
| title_sort | off pump coronary artery bypass grafting department of veteran affairs use and outcomes |
| topic | coronary artery bypass grafting long term survival myocardial infarction off‐pump surgery |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.023514 |
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