PMID- 32140350
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 12
IP  - 1
DP  - 2020 Jan 27
TI  - Conversion from Off to On-Pump Coronary Artery Bypass Grafting. Is it Avoidable?
PG  - e6791
LID - 10.7759/cureus.6791 [doi]
LID - e6791
AB  - Background With the emergence of new technologies to stabilize the heart off-pump 
      coronary artery bypass grafting (OPCAB), there is an increasing trend that is 
      being observed throughout the world. In certain circumstances, OPCAB needs to be 
      converted to on-pump CABG (ONCAB). In this study, we aim to identify certain risk 
      factors mandating conversions and their associated short-term outcomes. Methods 
      After approval from the institutional ethical review committee and exemption from 
      informed consent, retrospective data of 100 patients meeting the inclusion 
      criteria who underwent OPCAB operations at our institution from August 2018 to 
      July 2019 were included. Preoperative, intraoperative, and postoperative 
      variables were recorded and compared in conversion and non-conversion groups. 
      This study was conducted at the National Institute of Cardiovascular Diseases, 
      Karachi, Pakistan. Results A total of 100 patients were included in this study, 
      out of which 82% (82) were male, with age ranging between 18 and 77 years with a 
      mean age of 56.34 +/- 8.3 years. In nine of the cases, OPCAB was emergently 
      converted to ONCAB due to arrhythmias. In nine (9%) cases, off-pump CABG was 
      emergently converted to on-pump CABG (ONCAB). Emergent conversion was due to 
      arrhythmias in five cases, due to hypotension during OM graft in two cases, and 
      due to hypotension during ramus graft for the remaining two cases. The emergent 
      conversion was significantly associated with higher New York Heart Association 
      (NYHA) functional classification and comorbid conditions such as chronic 
      obstructive pulmonary disease (COPD). Conclusion Emergency conversion from 
      off-pump to OPCAB is the most catastrophic event causing higher morbidity and 
      mortality. Conversion rate was observed to be 9% with arrhythmias being the 
      common cause and patients with higher NYHA status and COPD at baseline were found 
      to be at increased risk of emergency conversion. Considering our results in 
      patients with diagnosed COPD and higher NYHA status, the decision for off-pump 
      CABG should be wisely taken carefully weighing the risks and benefits.
CI  - Copyright (c) 2020, Tariq et al.
FAU - Tariq, Khuzaima
AU  - Tariq K
AD  - Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK.
FAU - Zia, Kashif
AU  - Zia K
AD  - Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK.
FAU - Mangi, Ali
AU  - Mangi A
AD  - Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK.
FAU - Amanullah, Muneer
AU  - Amanullah M
AD  - Pediatric Cardiac Surgery, National Institute of Cardiovascular Disease, Karachi, 
      PAK.
FAU - Chaudry, Pervaiz A
AU  - Chaudry PA
AD  - Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK.
FAU - Karim, Musa
AU  - Karim M
AD  - Statistician, National Institute of Cardiovascular Diseases, Karachi, PAK.
LA  - eng
PT  - Journal Article
DEP - 20200127
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC7046009
OTO - NOTNLM
OT  - conversion
OT  - off-pump coronary artery bypass (opcab)
OT  - on-pump coronary artery bypass (oncab)
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/03/07 06:00
MHDA- 2020/03/07 06:01
PMCR- 2020/01/27
CRDT- 2020/03/07 06:00
PHST- 2020/03/07 06:00 [entrez]
PHST- 2020/03/07 06:00 [pubmed]
PHST- 2020/03/07 06:01 [medline]
PHST- 2020/01/27 00:00 [pmc-release]
AID - 10.7759/cureus.6791 [doi]
PST - epublish
SO  - Cureus. 2020 Jan 27;12(1):e6791. doi: 10.7759/cureus.6791.