Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: Results from the Danish On-pump Versus Off-pump Randomization Study (DOORS)

Kim Houlind; Morten Fenger-Grøn; Susanne J Holme; Bo J Kjeldsen; Susanne N Madsen; Bodil S Rasmussen; Mogens H Jepsen; Jan Ravkilde; Jens Aaroe; Peter Riis Hansen; Henrik Steen Hansen; Poul Erik Mortensen; for the DOORS Study Group

doi:10.1016/j.jtcvs.2014.02.024

Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: Results from the Danish On-pump Versus Off-pump Randomization Study (DOORS)

Kim Houlind, Morten Fenger-Grøn, Susanne J Holme, Bo J Kjeldsen, Susanne N Madsen, Bodil S Rasmussen, Mogens H Jepsen, Jan Ravkilde, Jens Aaroe, Peter Riis Hansen, Henrik Steen Hansen, Poul Erik Mortensen, for the DOORS Study Group

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

72 Citationer (Scopus)

Abstract

OBJECTIVE: To determine whether graft patency after on-pump and off-pump coronary artery bypass surgery is similar when performed using the same heparinization protocol.

METHODS: In a randomized, controlled, multicenter trial, 900 patients more than 70 years of age received either on-pump or off-pump coronary artery bypass surgery. Heparin was given to achieve an activated clotting time of 400 seconds before arteriotomy in both groups. After the procedure, protamine sulfate was given to revert the activated clotting time to less than 120 seconds. Coronary angiography was performed 6 months after the operation and graft patency was assessed by independent blinded observers.

RESULTS: A total of 481 patients underwent angiography. In the off-pump group, 561 (79%) of 710 grafts were open, 65 (9%) were stenotic, and 84 (12%) were occluded. In the on-pump group, 549 (86%) of 650 grafts were open, 38 (5%) were stenotic, and 63 (9%) were occluded. The difference between the proportion of open grafts was statistically significant in favor of on-pump surgery (P = .01). The proportion of open left internal thoracic artery grafts was 95% in both groups. Perioperative use of intracoronary shunts did not increase the risk of stenosis of the coronary artery distal to the anastomosis.

CONCLUSIONS: Despite comparable heparinization, graft patency after off-pump surgery was inferior to that after on-pump surgery.

Originalsprog	Engelsk
Tidsskrift	Journal of Thoracic and Cardiovascular Surgery
Vol/bind	148
Udgave nummer	5
Sider (fra-til)	1812–1819.e2
Antal sider	8
ISSN	0022-5223
DOI	https://doi.org/10.1016/j.jtcvs.2014.02.024
Status	Udgivet - 8 feb. 2014

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10.1016/j.jtcvs.2014.02.024

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Houlind, K., Fenger-Grøn, M., Holme, S. J., Kjeldsen, B. J., Madsen, S. N., Rasmussen, B. S., Jepsen, M. H., Ravkilde, J., Aaroe, J., Hansen, P. R., Hansen, H. S., Mortensen, P. E., & for the DOORS Study Group (2014). Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: Results from the Danish On-pump Versus Off-pump Randomization Study (DOORS). Journal of Thoracic and Cardiovascular Surgery, 148(5), 1812–1819.e2. https://doi.org/10.1016/j.jtcvs.2014.02.024

@article{9cb9e2602c5e42e5957ec36183bfbceb,

title = "Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: Results from the Danish On-pump Versus Off-pump Randomization Study (DOORS)",

abstract = "OBJECTIVE: To determine whether graft patency after on-pump and off-pump coronary artery bypass surgery is similar when performed using the same heparinization protocol.METHODS: In a randomized, controlled, multicenter trial, 900 patients more than 70 years of age received either on-pump or off-pump coronary artery bypass surgery. Heparin was given to achieve an activated clotting time of 400 seconds before arteriotomy in both groups. After the procedure, protamine sulfate was given to revert the activated clotting time to less than 120 seconds. Coronary angiography was performed 6 months after the operation and graft patency was assessed by independent blinded observers.RESULTS: A total of 481 patients underwent angiography. In the off-pump group, 561 (79%) of 710 grafts were open, 65 (9%) were stenotic, and 84 (12%) were occluded. In the on-pump group, 549 (86%) of 650 grafts were open, 38 (5%) were stenotic, and 63 (9%) were occluded. The difference between the proportion of open grafts was statistically significant in favor of on-pump surgery (P = .01). The proportion of open left internal thoracic artery grafts was 95% in both groups. Perioperative use of intracoronary shunts did not increase the risk of stenosis of the coronary artery distal to the anastomosis.CONCLUSIONS: Despite comparable heparinization, graft patency after off-pump surgery was inferior to that after on-pump surgery.",

author = "Kim Houlind and Morten Fenger-Gr{\o}n and Holme, {Susanne J} and Kjeldsen, {Bo J} and Madsen, {Susanne N} and Rasmussen, {Bodil S} and Jepsen, {Mogens H} and Jan Ravkilde and Jens Aaroe and Hansen, {Peter Riis} and Hansen, {Henrik Steen} and Mortensen, {Poul Erik} and {for the DOORS Study Group} and Kim Houlind and Kjeldsen, {Bo Juul} and Madsen, {Susanne N{\o}rgaard} and Rasmussen, {Bodil Steen} and Susanne Holme and Mortensen, {Poul Erik} and Hjortdal, {Vibeke E.} and Gert Lerbjerg and Uffe Niebuhr and S{\o}ren Aggestrup and Nielsen, {Per Hostrup} and J{\o}rn Sollid and J{\o}rgen Videb{\ae}k and Paul Sergeant and Elisabeth Stahle and Paulsen, {Peter Kildeberg} and Christian Hassager and Klausen, {Ib Chr.} and Grethe Andersen and Per Meden and Boris Modrau and S{\o}rensen, {Henrik Toft} and Johnsen, {S{\o}ren Paaske} and Andersen, {Niels Trolle} and Morten Fenger-Gr{\o}n and Andreasen, {Jan Jesper} and Haahr, {Poul Erik} and John Christensen and Jens Gr{\o}nlund and Jepsen, {Mogens Harrits} and Pallesen, {Peter Appel} and Jan Ravkilde and Jens Aar{\o}e and Hansen, {Peter Riis} and Hansen, {Henrik Steen} and Dorthe Dalsgaard and Henrik Munkholm and Lars Ehlers",

year = "2014",

month = feb,

day = "8",

doi = "10.1016/j.jtcvs.2014.02.024",

language = "English",

volume = "148",

pages = "1812–1819.e2",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

publisher = "Mosby, Inc.",

number = "5",

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Houlind, K, Fenger-Grøn, M, Holme, SJ, Kjeldsen, BJ, Madsen, SN , Rasmussen, BS, Jepsen, MH, Ravkilde, J, Aaroe, J, Hansen, PR, Hansen, HS, Mortensen, PE & for the DOORS Study Group 2014, 'Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: Results from the Danish On-pump Versus Off-pump Randomization Study (DOORS)', Journal of Thoracic and Cardiovascular Surgery, bind 148, nr. 5, s. 1812–1819.e2. https://doi.org/10.1016/j.jtcvs.2014.02.024

Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: Results from the Danish On-pump Versus Off-pump Randomization Study (DOORS). / Houlind, Kim; Fenger-Grøn, Morten; Holme, Susanne J et al.
I: Journal of Thoracic and Cardiovascular Surgery, Bind 148, Nr. 5, 08.02.2014, s. 1812–1819.e2.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols

T2 - Results from the Danish On-pump Versus Off-pump Randomization Study (DOORS)

AU - Houlind, Kim

AU - Fenger-Grøn, Morten

AU - Holme, Susanne J

AU - Kjeldsen, Bo J

AU - Madsen, Susanne N

AU - Rasmussen, Bodil S

AU - Jepsen, Mogens H

AU - Ravkilde, Jan

AU - Aaroe, Jens

AU - Hansen, Peter Riis

AU - Hansen, Henrik Steen

AU - Mortensen, Poul Erik

AU - for the DOORS Study Group

AU - Houlind, Kim

AU - Kjeldsen, Bo Juul

AU - Madsen, Susanne Nørgaard

AU - Rasmussen, Bodil Steen

AU - Holme, Susanne

AU - Mortensen, Poul Erik

AU - Hjortdal, Vibeke E.

AU - Lerbjerg, Gert

AU - Niebuhr, Uffe

AU - Aggestrup, Søren

AU - Nielsen, Per Hostrup

AU - Sollid, Jørn

AU - Videbæk, Jørgen

AU - Sergeant, Paul

AU - Stahle, Elisabeth

AU - Paulsen, Peter Kildeberg

AU - Hassager, Christian

AU - Klausen, Ib Chr.

AU - Andersen, Grethe

AU - Meden, Per

AU - Modrau, Boris

AU - Sørensen, Henrik Toft

AU - Johnsen, Søren Paaske

AU - Andersen, Niels Trolle

AU - Fenger-Grøn, Morten

AU - Andreasen, Jan Jesper

AU - Haahr, Poul Erik

AU - Christensen, John

AU - Grønlund, Jens

AU - Jepsen, Mogens Harrits

AU - Pallesen, Peter Appel

AU - Ravkilde, Jan

AU - Aarøe, Jens

AU - Hansen, Peter Riis

AU - Hansen, Henrik Steen

AU - Dalsgaard, Dorthe

AU - Munkholm, Henrik

AU - Ehlers, Lars

PY - 2014/2/8

Y1 - 2014/2/8

N2 - OBJECTIVE: To determine whether graft patency after on-pump and off-pump coronary artery bypass surgery is similar when performed using the same heparinization protocol.METHODS: In a randomized, controlled, multicenter trial, 900 patients more than 70 years of age received either on-pump or off-pump coronary artery bypass surgery. Heparin was given to achieve an activated clotting time of 400 seconds before arteriotomy in both groups. After the procedure, protamine sulfate was given to revert the activated clotting time to less than 120 seconds. Coronary angiography was performed 6 months after the operation and graft patency was assessed by independent blinded observers.RESULTS: A total of 481 patients underwent angiography. In the off-pump group, 561 (79%) of 710 grafts were open, 65 (9%) were stenotic, and 84 (12%) were occluded. In the on-pump group, 549 (86%) of 650 grafts were open, 38 (5%) were stenotic, and 63 (9%) were occluded. The difference between the proportion of open grafts was statistically significant in favor of on-pump surgery (P = .01). The proportion of open left internal thoracic artery grafts was 95% in both groups. Perioperative use of intracoronary shunts did not increase the risk of stenosis of the coronary artery distal to the anastomosis.CONCLUSIONS: Despite comparable heparinization, graft patency after off-pump surgery was inferior to that after on-pump surgery.

AB - OBJECTIVE: To determine whether graft patency after on-pump and off-pump coronary artery bypass surgery is similar when performed using the same heparinization protocol.METHODS: In a randomized, controlled, multicenter trial, 900 patients more than 70 years of age received either on-pump or off-pump coronary artery bypass surgery. Heparin was given to achieve an activated clotting time of 400 seconds before arteriotomy in both groups. After the procedure, protamine sulfate was given to revert the activated clotting time to less than 120 seconds. Coronary angiography was performed 6 months after the operation and graft patency was assessed by independent blinded observers.RESULTS: A total of 481 patients underwent angiography. In the off-pump group, 561 (79%) of 710 grafts were open, 65 (9%) were stenotic, and 84 (12%) were occluded. In the on-pump group, 549 (86%) of 650 grafts were open, 38 (5%) were stenotic, and 63 (9%) were occluded. The difference between the proportion of open grafts was statistically significant in favor of on-pump surgery (P = .01). The proportion of open left internal thoracic artery grafts was 95% in both groups. Perioperative use of intracoronary shunts did not increase the risk of stenosis of the coronary artery distal to the anastomosis.CONCLUSIONS: Despite comparable heparinization, graft patency after off-pump surgery was inferior to that after on-pump surgery.

U2 - 10.1016/j.jtcvs.2014.02.024

DO - 10.1016/j.jtcvs.2014.02.024

M3 - Journal article

C2 - 24613160

SN - 0022-5223

VL - 148

SP - 1812–1819.e2

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

IS - 5

ER -

Houlind K, Fenger-Grøn M, Holme SJ, Kjeldsen BJ, Madsen SN , Rasmussen BS et al. Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: Results from the Danish On-pump Versus Off-pump Randomization Study (DOORS). Journal of Thoracic and Cardiovascular Surgery. 2014 feb. 8;148(5):1812–1819.e2. doi: 10.1016/j.jtcvs.2014.02.024

Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: Results from the Danish On-pump Versus Off-pump Randomization Study (DOORS)

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