ArticleCureus2024
Predictors and Causes of Intraoperative Conversion From Off-Pump to On-Pump Coronary Artery Bypass: A Retrospective Study.
Article in Cureus, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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11 authors.
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Abstract
objectiveThis study evaluated the incidence, causes, and predictors of intraoperative conversion from off-pump coronary artery bypass grafting (OPCAB) to on-pump coronary artery bypass grafting (ONCAB), identifying risk factors to improve surgical planning.
methodsThis retrospective case-control study included patients who underwent OPCAB at the Peshawar Institute of Cardiology, Peshawar, Pakistan, between December 8, 2021, and December 7, 2023. Among 714 patients, 27 (3.78%) required conversion to ONCAB. For comparison, 108 (15.1%) controls were randomly selected from those who completed OPCAB successfully. Preoperative and intraoperative data were analyzed, and logistic regression identified predictors of conversion.
resultsThe most frequent cause of conversion was hemodynamic instability, which occurred in 18 (66.67%) cases. Persistent hypotension and ST-segment changes lasting approximately 10-20 minutes were primary indicators before conversion, highlighting the need for close intraoperative monitoring. Left main coronary artery stenosis of 50%-70% emerged as the only independent predictor of conversion (odds ratio (OR) 7.60, 95% CI: 2.91-19.83, p < 0.001). This study emphasizes the importance of robust patient selection criteria, especially for cases with borderline coronary anatomy.
conclusionHemodynamic instability and moderate left main coronary artery stenosis significantly contribute to OPCAB-to-ONCAB conversion. Enhanced preoperative imaging and hemodynamic management protocols can potentially reduce conversion rates, improving surgical outcomes.
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