Cor Vasa 2018, 60(4):e393-e399 | DOI: 10.1016/j.crvasa.2018.01.005

Use of OPCAB in Czechia 2010-2015: Have we learned any lessons?

Jan Hlavička^a,*, Tomáš Vaněk^a, Jiří Jarkovský^b,c, Klára Benešová^b,c

^a Kardiocentrum, Kardiochirurgická klinika, 3. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha, Česká republika

^b Ústav zdravotnických informací a statistiky ČR, Praha, Česká republika

^c Institut biostatistiky a analýz, Lékařská fakulta Masarykovy univerzity, Brno, Česká republika

Introduction: Off-pump coronary artery bypass grafting (OPCAB) is a well-established technique for coronary revascularization, which is used worldwide as well as in the Czech Republic (CZ). However, the number of patients undergoing this procedure varies from department to department. We wanted to see if the very latest publications regarding off-pump coronary revascularization had changed the way the procedure was viewed by Czech heart surgeons.

Methods: Data from the Czech National Register of Cardiac Surgery were used to evaluate trends in the number OPCAB cases, in patients with ischemic heart disease, and to analyze the factors that surgeons routinely used when opting for the OPCAB strategy. The study period was 2010-2015.

Results: OPCAB was performed at all 12 cardiac surgery departments in the CZ. Overall, we found a slight decrease of the total number of isolated revascularizations in the CZ per annum between 2010 and 2015 (from 3884 to 3569), the percentage of OPCAB cases also declined over the study period (from 26.7% to 24.9%). Over the study, the average age of OPCAB patients increased (66.2 vs. 68.1 years) and included patients with increasingly greater numbers of comorbidities. The average total OPCAB surgery time decreased (3.3 vs. 3.1 hours) and compared to standard revascularization, OPCAB took significantly less time (3.1 vs. 3.3 hours, p < 0001). The number of peripheral anastomosis performed off-pump was significantly lower than on cardiopulmonary bypass (CPB) and, in general, has decreased (2.1 vs. 3.0, p < 0.001 in 2010 and 1.9 vs. 2.9, p < 0.001 in 2015 resp.).

Conclusions: The prevalence of OPCAB in the Czech Republic has decreased. However, it is unclear whether this is due to the recent widely respected prospective randomized clinical trials. Published papers have not shown the superiority of OPCAB in high-risk patients, yet Czech cardiac surgeons prefer this strategy, especially in patients with a history of renal insufficiency. In that point, the community of Czech cardiac surgeons seems to have become more conservative with a trend toward incomplete revascularization.

Keywords: Cardiopulmonary bypass; Off-pump; Revascularization

Received: October 14, 2017; Revised: January 9, 2018; Accepted: January 13, 2018; Published: August 1, 2018  Show citation