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Fewer off-pump CABG procedures performed in past decade
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TORONTO — Use of off-pump CABG has declined in the past decade, from 23% in 2002 to 17% in 2012, according to data presented at the American Association for Thoracic Surgery Annual Meeting.
Using data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database, Faisal G. Bakaeen, MD, FACS, and colleagues analyzed more than 2 million primary CABG operations to track the use of off-pump CABG from 1997 to 2012.
“Little is known about the extent to which [off-pump CABG] has been accepted into cardiac surgery practices,” Bakaeen, chief of cardiothoracic surgery at the Michael E. DeBakey VA Medical Center and associate professor of surgery at Baylor College of Medicine, said during a presentation.
Faisal G. Bakaeen
Researchers categorized the volume of procedures based on centers and surgeons.
By 2012, 84% of centers performed 50 or fewer off-pump CABG procedures per year, 34% did not perform any off-pump procedures and 86% of surgeons performed 20 or fewer off-pump procedures per year. According to these results, fewer than one in five patients who undergo surgical coronary revascularization undergo an off-pump procedure, according to Bakaeen.
The conversion rate remained about 6% during the study period, with the exception of 2003 when the rate was 7.8%.
Bakaeen hypothesized that the learning curve of off-pump CABG may be one reason why the procedure appears to have fallen out of favor with cardiac surgeons. “We speculate that it’s because [off-pump CABG] is a more technically demanding operation,” said Bakaeen, a member of the Cardiology Today’s Intervention Editorial Board.
In an interview with Cardiology Today, Bakaeen said several randomized trials have demonstrated no significant difference between off-pump and on-pump CABG regarding major outcomes. In addition, the off-pump procedure has been previously associated with decreased graft patency and less complete revascularization. “Both of those variables affect long-term outcomes,” he said.
Despite the declining rate of off-pump CABG use, there are patients in whom an off-pump procedure is preferable to an on-pump procedure, according to Bakaeen. “This includes patients with diseases descending aortas, in whom it would be hazardous to manipulate the aorta, and patients with advanced liver disease, in whom there may be deleterious effects of the on-pump procedure on liver function,” he said. – by Louise Gagnon
For more information:
Bakaeen FG. Abstract #78. Presented at: American Association for Thoracic Surgery Annual Meeting; April 26-30, 2014; Toronto.
Disclosure: Bakaeen reports no relevant financial disclosures.