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On-Pump CABG Should Be Avoided in Patients With Liver Cirrhosis: Presented at STS By Charlene Laino FORT LAUDERDALE, Fla -- January 27, 2010 -- On-pump coronary artery bypass graft surgery (CABG) should be avoided in patients with liver cirrhosis, researchers reported here on January 26 at the Society of Thoracic Surgeons (STS) 46th Annual Meeting. Although liver cirrhosis is a major risk factor for cardiac surgery using cardiopulmonary bypass surgery, there are very little data on outcomes among these patients, said Akira Marui, MD, Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Therefore, researchers took advantage of the large Coronary Revascularization Demonstrating Outcome in Kyoto (CREDO-Kyoto) Registry to look at outcomes among 204 Japanese patients with multivessel disease and liver cirrhosis from 30 institutions who received percutaneous coronary intervention (PCI) or off-pump CABG from 2000 to 2002. The mean age of the patients was 68 years and 148 were male. Of the patients, 128 received PCI, 34 underwent off-pump CABG, and 42 received on-pump CABG. Age and preoperative left ventricular ejection fraction were not different among the 3 groups. The number of patients with 3-vessel disease was lower in the PCI-treated group (P < .01). The median follow-up time was 3.5 years. The overall in-hospital mortality rates among patients who received PCI, off-pump CABG, and on-pump CABG were 1%, 0%, and 10%, respectively (P < .01 for on-pump CABG vs PCI). However, none of the patients who received PCI had a stroke, compared with 6% of patients who underwent off-pump CABG and 2% who had on-pump CABG (P = .03). “Bleeding was also significantly lower in the PCI arm [P = .02],” Dr. Marui said. The overall mortality rates during the whole study period among patients who received PCI, off-pump CABG, and on-pump CABG were 25%, 26%, and 24%, respectively (P = 0.88). The cardiovascular mortality rates were 12%, 6%, and 11% among the 3 groups, respectively, (P = .61). In multivariate analysis, on-pump CABG reduced the incidence of cardiovascular mortality by 17% (P = .8) and off-pump CABG reduced mortality by 71% (P = .11), compared with PCI. “Overall mortality was high regardless of the revascularisation strategy,” Dr. Marui said. “On-pump CABG should be avoided if possible because of high in-hospital mortality and morbidity. PCI was advantageous in terms of avoiding early complications, but the long-term results did not differ from those of CABG,” Dr. Marui said. [Presentation title: What Is the Optimal Revascularization Strategy in Patients With Liver Cirrhosis? Insights From CREDO Kyoto Registry. Abstract 14] E-mail this page to a friend or colleague! To print, use this version