gms | German Medical Science

EbM in Qualitätsmanagement und operativer Medizin
8. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin e. V.

Deutsches Netzwerk Evidenzbasierte Medizin e. V.

22.03. - 24.03.2007 in Berlin

Beating versus arrested heart coronary revascularization: randomized controlled trial in 596 unselected patients (3cab-study)

Meeting Abstract

  • corresponding author presenting/speaker Jochen Börgermann - Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland
  • K. Hakim - Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland
  • O. Kuss - Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland
  • A. Simm - Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland
  • R.J. Scheubel - Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland
  • H. Kroll - Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland
  • S. Schlünken - Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland
  • N. Ali - Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland
  • R.E. Silber - Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland
  • I. Friedrich - Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Deutschland

EbM in Qualitätsmanagement und operativer Medizin. 8. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin e. V.. Berlin, 22.-24.03.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07ebm061

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/ebm2007/07ebm061.shtml

Published: March 15, 2007

© 2007 Börgermann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective

So far, no studies have distinguished the specific contribution of surgical trauma, extracorporeal circulation, and ischemia/reperfusion to clinical outcome in coronary revascularization. This prospective randomized study aimed to assess the impact of each of the above noxious mechanism in an unselected patient population.

Methods

A total of 596 consecutive unselected patients scheduled for isolated coronary revascularization were randomized into three groups: OPCAB (off-pump coronary artery bypass grafting, n=199), CPB-CABG (on-pump revascularization with cardioplegic arrest, n=201), and PACAB (pump-assisted beating heart procedure, n=196). The only exclusion criteria were re-operation or emergency procedures. The following events served as primary endpoints: death within 30 days, stroke, myocardial infarction, low-output syndrome, duration of artificial ventilation ≥ 24h, or new requirement for hemodialysis. Data analysis was based on the intention-to-treat principle.

Results

Mean patient age was 67 years, 76% of patients were male, the median EuroSCORE was 3 points. Intraoperative conversion to a different technique was required in 5.5% of patients. We observed 42 events (21.1%) in the OPCAB, 33 (16.4%) in the CPB, and 43 (21.9%) in the PACAB group, a non-significant treatment difference (p=0.33). The relative risk associated with OPCAB was 1.29 (95%-CI: [0.85;1.94]), and with PACAB 1.34 (95%-CI: [0.89;2.01], both compared to CPB).

Conclusion

Comparison of the operative techniques OPCAB, CPB-CABG, and PACAB revealed that all three are associated with identical in-hospital outcome and identical 30 day lethality. One can conclude that the noxious mechanisms do not appear to have additive effects; the clinical outcome is rather determined by the surgical trauma alone.