PMID- 22619318 OWN - NLM STAT- MEDLINE DCOM- 20131104 LR - 20130211 IS - 1873-734X (Electronic) IS - 1010-7940 (Linking) VI - 43 IP - 3 DP - 2013 Mar TI - Surgical treatment of left main disease and severe carotid stenosis: does the off-pump technique provide a better outcome? PG - 541-8; discussion 548 LID - 10.1093/ejcts/ezs277 [doi] AB - OBJECTIVES: Left main disease (LMD), combined with carotid artery stenosis (CAS), constitutes a high-risk patient population. Priority is often given to coronary revascularization, due to the severity of the angina. However, the choice of revascularization strategy [off-pump coronary artery bypass (OPCAB) vs coronary artery bypass grafting (CABG)] remains elusive. METHODS: A total of 1340 patients with LMD were non-randomly assigned to either on-pump (CABG group, n = 680) or off-pump (OPCAB group, n = 634) revascularization between 1 January 2006 and 21 September 2010. Multivariable regression was used to determine the risk-adjusted impact of a revascularization strategy on a composite in-hospital outcome (MACCE), and proportional hazards regression was used to define the variables affecting long-term survival. RESULTS: Significant CAS was found in 130 patients: 84 (13.1%) patients underwent OPCAB, while 46 patients (6.8%) underwent CABG (P < 0.05). Patients with a history of stroke/transient ischaemic attack were also more likely to receive OPCAB (7.1 vs 4.7%; P = 0.08). OPCAB patients were older, in a higher New York Heart Association (NYHA) class, with a lower LVEF and higher EuroSCORE. A calcified aorta was found in 79 patients [OPCAB-CABG: 49 (7.73%) vs 30 (4.41%); P = 0.016] and resulted in a less complex revascularization (OPCAB-CABG: 2.3 +/- 0.71 vs 3.19 +/- 0.82; P < 0.05), and 30-day mortality was insignificantly higher in the CABG (2.7 vs 2.8%) as well as MACCE (11.2 vs 12.2%; P = NS). This trend reversed when late mortality was evaluated; however, it did not reach significance at 60 months. Preoperative renal impairment requiring dialysis was found to be a technique-independent predictor of MACCE. The number of arterial conduits also influenced MACCE. CONCLUSIONS: Off-pump coronary revascularization may offer risk reduction of neurological complications in patients with a significant carotid artery disease and a history of previous stroke, but a larger study population is needed to support this thesis. The growing discrepancy in long-term survival should draw attention to a more complete revascularization in OPCAB patients. FAU - Zembala, Michael O AU - Zembala MO AD - Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze, Poland. m.zembala.jr@sccs.pl FAU - Filipiak, Krzysztof AU - Filipiak K FAU - Ciesla, Daniel AU - Ciesla D FAU - Pacholewicz, Jerzy AU - Pacholewicz J FAU - Hrapkowicz, Tomasz AU - Hrapkowicz T FAU - Knapik, Piotr AU - Knapik P FAU - Przybylski, Roman AU - Przybylski R FAU - Zembala, Marian AU - Zembala M LA - eng PT - Clinical Trial PT - Comparative Study PT - Journal Article DEP - 20120522 PL - Germany TA - Eur J Cardiothorac Surg JT - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JID - 8804069 SB - IM MH - Aged MH - Carotid Stenosis/*surgery MH - Coronary Artery Bypass/adverse effects/*methods/standards MH - Coronary Artery Bypass, Off-Pump/adverse effects/*methods/standards MH - Coronary Artery Disease/*surgery MH - Female MH - Humans MH - Ischemic Attack, Transient/physiopathology MH - Kaplan-Meier Estimate MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Retrospective Studies MH - Statistics, Nonparametric MH - Stroke/physiopathology MH - Treatment Outcome EDAT- 2012/05/24 06:00 MHDA- 2013/11/05 06:00 CRDT- 2012/05/24 06:00 PHST- 2012/05/24 06:00 [entrez] PHST- 2012/05/24 06:00 [pubmed] PHST- 2013/11/05 06:00 [medline] AID - ezs277 [pii] AID - 10.1093/ejcts/ezs277 [doi] PST - ppublish SO - Eur J Cardiothorac Surg. 2013 Mar;43(3):541-8; discussion 548. doi: 10.1093/ejcts/ezs277. Epub 2012 May 22.