TY - JOUR
T1 - Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols
T2 - results from the Danish On-pump Versus Off-pump Randomization Study (DOORS)
AU - Houlind, Kim Christian
AU - Fenger-Grøn, Morten
AU - Juel Holme, Susanne
AU - Juel Kjeldsen, Bo
AU - Madsen, Susanne Nørgaard
AU - Rasmussen, Bodil Steen
AU - Harrits Jepsen, Mogens
AU - Ravkilde, Jan
AU - Aarøe, Jens
AU - Hansen, Peter Riis
AU - Hansen, Henrik Steen
AU - Mortensen, Poul Erik
N1 - Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2014/11
Y1 - 2014/11
N2 - OBJECTIVE: To determine whether graft patency after on-pump and off-pump coronary artery bypass surgery is similar when performed using the same heparinization protocol.METHODS: In a randomized, controlled, multicenter trial, 900 patients more than 70 years of age received either on-pump or off-pump coronary artery bypass surgery. Heparin was given to achieve an activated clotting time of 400 seconds before arteriotomy in both groups. After the procedure, protamine sulfate was given to revert the activated clotting time to less than 120 seconds. Coronary angiography was performed 6 months after the operation and graft patency was assessed by independent blinded observers.RESULTS: A total of 481 patients underwent angiography. In the off-pump group, 561 (79%) of 710 grafts were open, 65 (9%) were stenotic, and 84 (12%) were occluded. In the on-pump group, 549 (86%) of 650 grafts were open, 38 (5%) were stenotic, and 63 (9%) were occluded. The difference between the proportion of open grafts was statistically significant in favor of on-pump surgery (P=.01). The proportion of open left internal thoracic artery grafts was 95% in both groups. Perioperative use of intracoronary shunts did not increase the risk of stenosis of the coronary artery distal to the anastomosis.CONCLUSIONS: Despite comparable heparinization, graft patency after off-pump surgery was inferior to that after on-pump surgery.
AB - OBJECTIVE: To determine whether graft patency after on-pump and off-pump coronary artery bypass surgery is similar when performed using the same heparinization protocol.METHODS: In a randomized, controlled, multicenter trial, 900 patients more than 70 years of age received either on-pump or off-pump coronary artery bypass surgery. Heparin was given to achieve an activated clotting time of 400 seconds before arteriotomy in both groups. After the procedure, protamine sulfate was given to revert the activated clotting time to less than 120 seconds. Coronary angiography was performed 6 months after the operation and graft patency was assessed by independent blinded observers.RESULTS: A total of 481 patients underwent angiography. In the off-pump group, 561 (79%) of 710 grafts were open, 65 (9%) were stenotic, and 84 (12%) were occluded. In the on-pump group, 549 (86%) of 650 grafts were open, 38 (5%) were stenotic, and 63 (9%) were occluded. The difference between the proportion of open grafts was statistically significant in favor of on-pump surgery (P=.01). The proportion of open left internal thoracic artery grafts was 95% in both groups. Perioperative use of intracoronary shunts did not increase the risk of stenosis of the coronary artery distal to the anastomosis.CONCLUSIONS: Despite comparable heparinization, graft patency after off-pump surgery was inferior to that after on-pump surgery.
U2 - 10.1016/j.jtcvs.2014.02.024
DO - 10.1016/j.jtcvs.2014.02.024
M3 - Journal article
C2 - 24613160
VL - 148
SP - 1812-1819.e2
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
IS - 5
ER -