Faculty Collaboration Database

Chronic obstructive pulmonary disease impact upon outcomes: the veterans affairs randomized on/off bypass trial. Ann Thorac Surg 2013 Oct;96(4):1302-1309

Date

08/07/2013

Pubmed ID

23915589

DOI

10.1016/j.athoracsur.2013.05.055

Scopus ID

2-s2.0-84885319380 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are at inherent risk for higher rates of adverse events after coronary artery bypass graft surgery (CABG). As compared with on-pump CABG (ONCAB), it has been suggested that beating heart or off-pump CABG (OPCAB) may differentially benefit high-risk COPD patients.

METHODS: Intraoperative, 30-day and 1-year outcomes were compared for COPD patients randomized to OPCAB (n = 220) versus ONCAB (n = 238) within the Veterans Affairs' Randomized On/Off Bypass (ROOBY) trial. As COPD patients may more likely incur adverse post-CABG outcomes, a propensity analysis was performed comparing all ROOBY patients with COPD (n = 458) versus those without COPD (n = 1,745).

RESULTS: For COPD patients, the baseline characteristics were similar between the 2 revascularization approaches. In these patients, the intraoperative complication rate was higher with OPCAB than ONCAB (21.9% vs 10.1%, respectively; p < 0.001), but there were no significant differences in the 30-day (7.3% vs 7.6%, p = 1.00) or 1-year composite outcome rates (9.5% vs 7.1%, p = 0.39) between the groups. Comparing the COPD patients with propensity-matched non-COPD patients, there was no difference in 1-year major adverse cardiovascular events (including the 1-year composite major adverse cardiac events (MACE) outcome, as well as the individual MACE outcomes for all cause death, acute myocardial infarction, or repeat revascularization).

CONCLUSIONS: In COPD patients, there were more intraoperative complications and no differences in 30-day or 1-year outcomes with OPCAB as compared with ONCAB. Similar to patients without COPD, there was no benefit to using an OPCAB approach in COPD patients.

Author List

Almassi GH, Shroyer AL, Collins JF, Hattler B, Bishawi M, Baltz JH, Ebrahimi R, Grover FL

Author

G Hossein Almassi MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Coronary Artery Bypass
Coronary Artery Disease
Humans
Middle Aged
Pulmonary Disease, Chronic Obstructive
United States
United States Department of Veterans Affairs
Veterans