Surgeons’ preference for off pump or on pump coronary artery bypass
grafting surgery: different level, different strategy?
Abstract
Background: Surgeon‘s preference is an important factor in clinical
strategy for off pump (OPCAB) or on pump (ONCAB) coronary artery bypass
graft (CABG) surgery. This study analyzed the surgeons’ understanding
and the propensity for both techniques. Methods: A self-reported
questionnaire survey was performed. Two sections were included :(1) Q1
questionnaire: to investigate the surgeon’s opinion on the indications
of OPCAB and ONCAB; (2) Q2 questionnaire: to investigate the surgeons’
choice of OPCAB or ONCAB in different clinical situations. Results: The
questionnaires were sent to 169 surgeons. In Q1 questionnaire, 71.2%
surgeons surveyed chose the option which represents that the degree of
overlap between the indications of OPCAB and ONCAB would be greater than
70%. 55.1% surgeons believed that OPCAB had a wider scope of
indications than ONCAB, while 35.3% surgeons believed that ONCAB had
more extensive indications than OPCAB. In Q2 questionnaire, more than
70% of surgeons surveyed chose OPCAB for patients at high risk of
stroke, with renal dysfunction, pulmonary dysfunction, malignancy,
clotting and coagulation disorders or octogenarian patients, while more
than 57.5% of surgeons surveyed chose ONCAB with the conditions of poor
target vessels, ventricular enlargement and dysfunction. 87.5% surgeons
made the choice of ONCAB for novice surgeons. Conclusion: Most surgeons
surveyed agreed that OPCAB and ONCAB are suitable for most of the
patients. Surgeons are more willing to choose ONCAB when facing
complicated heart conditions, while choose OPCAB in the presence of more
serious concomitant diseases.