On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation. Analysis from the polish national registry of cardiac surgery procedures (KROK)

• Published in: PloS one Vol. 15; no. 4; p. e0231950
• Main Authors: Kowalewski, Mariusz, Jasiński, Marek, Staromłyński, Jakub, Zembala, Marian, Widenka, Kazimierz, Brykczyński, Mirosław, Skiba, Jacek, Zembala, Michał, Bartuś, Krzysztof, Hirnle, Tomasz, Dziembowska, Inga, Knapik, Piotr, Tobota, Zdzisław, Maruszewski, Bohdan, Suwalski, Piotr
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 22.04.2020; Public Library of Science (PLoS)
• Subjects: Cardiac arrhythmia; Cardiovascular disease; Coronary artery; Coronary vessels; Dentistry; Fibrillation; Heart; Heart attacks; Heart surgery; Hospitals; Hypertension; Kopernik, Mikolaj (Nicolaus Copernicus) (1473-1543); Medical education; Medicine and Health Sciences; Mortality; Patients; Pediatrics; Statistical models; Surgery; Survival; Thoracic surgery; Variables; Vascular surgery; Poland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0231950

No single randomized study has ever before addressed the safety of On-Pump coronary artery bypass grafting (CABG) vs Off-Pump CABG in the setting of atrial fibrillation (AF) and data from small observational samples remain inconclusive. Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Of initial 188,972 patients undergoing CABG, 7,913 presented with baseline AF (76.0% men, mean age 69.1±8.2) and underwent CABG without concomitant valve surgery between 2006-2019 in 37 reference centers across Poland. Mean follow-up was 4.7±3.5 years (median 4.3 IQR 1.7-7.4). Cox proportional hazards models were used for computations. Of included patients, 3,681 underwent On-Pump- (46.52%) as compared to 4,232 (53.48%) who underwent Off-Pump CABG. Patients in the latter group less frequently were candidates for complete revascularization (P<0.001). In an unadjusted comparison, On-Pump surgery was associated with significantly worse survival at 30 days: HR: 1.28; 95%CIs: (1.07-1.53); P = 0.007. Along the 13-year study period, the trend shifted in favor of On-Pump CABG: HR: 0.92; 95%CIs: (0.83-0.99); P = 0.005. After rigorous propensity matching, 636 pairs were identified. The direction and magnitude of treatment effects was sustained with HRs of 3.58; (95%CIs: 1.34-9.61); p = 0.001 and 0.74; [95%CIs: 0.56-0.98]; p = 0.036) for 30-day and late mortality respectively. Off-Pump CABG offered 30-day survival benefit to patients undergoing CABG surgery and presenting with underlying AF. On-Pump CABG was associated with significantly improved survival at long term.