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; DOORS Study Group; Christian Hassager

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, DOORS Study Group, Christian Hassager

Department of Clinical Medicine

54 Citations (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.

Original language	English
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	148
Issue number	5
Pages (from-to)	1812-1819.e2
Number of pages	10
ISSN	0022-5223
DOIs	https://doi.org/10.1016/j.jtcvs.2014.02.024
Publication status	Published - 1 Nov 2014

Keywords

Aged
Anticoagulants
Cardiopulmonary Bypass
Coronary Angiography
Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump
Coronary Vessels
Denmark
Drug Administration Schedule
Female
Heparin
Heparin Antagonists
Humans
Male
Protamines
Risk Factors
Time Factors
Treatment Outcome
Vascular Patency

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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., DOORS Study Group, & Hassager, C. (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

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.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 5, 01.11.2014, p. 1812-1819.e2.

Research output: Contribution to journal › Journal article › Research › peer-review

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, DOORS Study Group & Hassager, C 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, vol. 148, no. 5, pp. 1812-1819.e2. https://doi.org/10.1016/j.jtcvs.2014.02.024

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 Nov 1;148(5):1812-1819.e2. doi: 10.1016/j.jtcvs.2014.02.024

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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.",

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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 {DOORS Study Group} and Christian Hassager",

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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 - DOORS Study Group

AU - Hassager, Christian

PY - 2014/11/1

Y1 - 2014/11/1

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.

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KW - Anticoagulants

KW - Cardiopulmonary Bypass

KW - Coronary Angiography

KW - Coronary Artery Bypass

KW - Coronary Artery Bypass, Off-Pump

KW - Coronary Vessels

KW - Denmark

KW - Drug Administration Schedule

KW - Female

KW - Heparin

KW - Heparin Antagonists

KW - Humans

KW - Male

KW - Protamines

KW - Risk Factors

KW - Time Factors

KW - Treatment Outcome

KW - Vascular Patency

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 -

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

Keywords

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