167 posters, 28 videos, 9 topics, 12 sessions, 337 authors, 160 institutions

ISMICS 2023 Annual Meeting

31 May - 3 June, 2023 | Boston, MA

PC21

National Trend Of On-pump Versus Off-pump Coronary Artery Bypass Grafting In Veterans

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Poster Presenter

Sarah Halbert

Authors

Sarah Halbert, Jared Antevil, Gregory Trachiotis

Affiliations

Veterans Affairs Medical Center, Washington DC Veterans Affairs Medical Center; MedStar Georgetown University Hospital, Washington DC Veterans Affairs Medical Center; George Washington University School of Medicine and Health Sciences

Part of Topic

Coronary Revascularization

National Trend in On-pump versus Off-pump Coronary Artery Bypass Grafting in Veterans

•There is interest in performing CABG without the use of cardiopulmonary bypass (“off pump”) in order to potentially reduce morbidity and length of hospitalization and recovery.

•However, there remains no consensus on best use, with conflicting outcomes results from RCTs, cohort, and registry-based studies.

•Investigation within the US Veteran population remains limited.

We aimed to evaluate usage trends and perioperative outcomes of ON- and OFF-pump CABG in United States (US) Veterans.

•Retrospective review of prospectively collected Veterans Affairs records: CDW, VINCI, VASQIP

•Patients who underwent isolated CABG between 2008-2021, divided into groups based on ON- vs OFF-pump technique

•Propensity matching performed using nearest neighbor algorithm and a 0.1 caliper for preoperative risk factors.

•Cox Proportional-Hazards models were used to analyze the independent association between technique and outcomes.

The proportion of off-pump procedures decreased: 18.8% between 2008-2012, 11.6% between 2013-2017, and 8.6% from 2018-2021 (X2=712.78, df=2, p<.001).

Groups were propensity matched with respect to age, left ventricular ejection fraction, and histories of COPD, DM, HTN, smoking, and prior cardiac surgery.

•Patients who underwent On-pump CABG had increased rates of death, stroke, acute renal failure, atrial fibrillation, and prolonged intubation at 30 days postoperatively

•On-pump patients experienced increased length of stay (Beta=0.05, p<.001)

Even though off-pump CABG is independently associated with decreased risk of perioperative morbidity and mortality, its use within the VA system is decreasing over time, suggesting more selective use as overall volume has decreased. The use of off-pump CABG has the potential to improve perioperative outcomes, and it remains an important tool for revascularization in the veteran population.