HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mats J. Synnergren Rolf Ekroth Lars Wiklund Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Synnergren, M. J. Articles by Wiklund, L. Search for Related Content PubMed Articles by Synnergren, M. J. Articles by Wiklund, L. Related Collections Coronary disease

J Thorac Cardiovasc Surg 2008;136:29-36
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Incomplete revascularization reduces survival benefit of coronary artery bypass grafting: Role of off-pump surgery

Department of Molecular and Clinical Medicine/Cardiothoracic Surgery, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.

Received for publication January 21, 2007; revisions received July 5, 2007; accepted for publication July 10, 2007.

^_* Address for reprints: Mats J. Synnergren, MD, PhD, Children's Heart Centre, The Queen Silvia Children's Hospital, 416 85 Göteborg, Sweden. (Email: mats.synnergren{at}vgregion.se).

Objective: We sought to analyze the influence, if any, of incomplete revascularization and on/off-pump techniques on long-term mortality after coronary artery bypass grafting.

Methods: A total of 9408 patients undergoing coronary artery bypass grafting, 8461 on pump and 947 off pump, operated on between 1995 and 2004 were included in the study. Adjusted hazard function for long-term mortality was estimated with Poisson regression analysis in a model that included variables reflecting completeness of revascularization, operative method (on/off pump), and background risk factors for death.

Results: Mean follow-up after surgical intervention for survivors was 5.0 ± 2.8 years (range, 0.5–10.5 years), with a total follow-up of 45,076 patient years. Leaving 1 diseased vascular segment without a bypass graft in 2- or 3-vessel disease did not increase the hazard ratio for death in comparison with complete revascularization (hazard ratio, 1.05; 95% confidence interval, 0.87–1.27; P = .60). In contrast, leaving 2 vascular segments without a bypass graft in 3-vessel disease was associated with an increased hazard ratio for death (hazard ratio, 1.82; 95% confidence interval, 1.15–2.85; P = .01). Incomplete revascularization was more common in the off-pump group (P < .001) in our study. If adjusting for incomplete revascularization, there was no significant influence of the use of on/off-pump techniques on the hazard ratio for death (hazard ratio, 1.08; 95% confidence interval, 0.82–1.40; P = .57).

Conclusions: Incomplete revascularization of patients with 3-vessel disease is an independent risk factor for increased long-term mortality after coronary artery bypass grafting. In contrast, the use of on- or off-pump techniques had no significant effect on survival after adjusting for incomplete revascularization.

This article has been cited by other articles:

				S. J. Head, M. J. Mack, D. R. Holmes Jr, F. W. Mohr, M.-C. Morice, P. W. Serruys, and A. P. Kappetein Incidence, predictors and outcomes of incomplete revascularization after percutaneous coronary intervention and coronary artery bypass grafting: a subgroup analysis of 3-year SYNTAX data Eur J Cardiothorac Surg, December 21, 2011; (2011) ezr105v1. [Abstract] [Full Text] [PDF]

				Y.-T. Tsai, F.-Y. Lin, C.-H. Lai, Y.-C. Lin, C.-Y. Lin, and C.-S. Tsai On-pump beating-heart coronary artery bypass provides efficacious short- and long-term outcomes in hemodialysis patients Nephrol. Dial. Transplant., September 27, 2011; (2011) gfr536v1. [Abstract] [Full Text] [PDF]

				Y.-H. Kim, D.-W. Park, J.-Y. Lee, W.-J. Kim, S.-C. Yun, J.-M. Ahn, H. G. Song, J.-H. Oh, J. S. Park, S.-J. Kang, et al. Impact of Angiographic Complete Revascularization After Drug-Eluting Stent Implantation or Coronary Artery Bypass Graft Surgery for Multivessel Coronary Artery Disease Circulation, May 31, 2011; 123(21): 2373 - 2381. [Abstract] [Full Text] [PDF]

				M. Ouzounian, A. Hassan, A. M. Yip, K. J. Buth, R. J. F. Baskett, I. S. Ali, and G. M. Hirsch The impact of sequential grafting on clinical outcomes following coronary artery bypass grafting Eur J Cardiothorac Surg, November 1, 2010; 38(5): 579 - 584. [Abstract] [Full Text] [PDF]

				H. Takagi, M. Matsui, and T. Umemoto Off-Pump Coronary Artery Bypass May Increase Late Mortality: A Meta-Analysis of Randomized Trials Ann. Thorac. Surg., June 1, 2010; 89(6): 1881 - 1888. [Abstract] [Full Text] [PDF]

				S. Hu, Z. Zheng, X. Yuan, W. Wang, Y. Song, H. Sun, and J. Xu Increasing Long-Term Major Vascular Events and Resource Consumption in Patients Receiving Off-Pump Coronary Artery Bypass: A Single-Center Prospective Observational Study Circulation, April 27, 2010; 121(16): 1800 - 1808. [Abstract] [Full Text] [PDF]

				G. F. V. Panday, S. Fischer, A. Bauer, D. Metz, J. Schubel, N. E. Shouki, T. Eberle, and H. Hausmann Minimal extracorporeal circulation and off-pump compared to conventional cardiopulmonary bypass in coronary surgery Interact CardioVasc Thorac Surg, November 1, 2009; 9(5): 832 - 836. [Abstract] [Full Text] [PDF]