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Objective. The learning curve of coronary artery bypass grafting with multiple arterial grafting and without the use of cardiopulmonary bypass (off‐pump) is perceived as an advanced subspeciality associated with increased surgical risk. We compared the trends and early clinical outcomes between trainees and consultants as the first operator in the United Kingdom. Methods. All patients who underwent elective or urgent isolated coronary artery bypass grafting from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. Trends and early clinical outcomes between trainees and consultants as the first operator were compared in the whole cohort and after propensity score matching. Results. Of the total coronary artery bypass graft procedures, trainees performed 24.39% (n = 79759/327025). Trainees performed 27.10% (63934/235920) on‐pump without multiple arterial graft procedures compared to consultants. The consultants had a shorter cardiopulmonary bypass time (82.81 (SD: 35.36) vs 86.21 (SD: 30.07) minutes, p < 0.001) and aortic cross‐clamp time (48.05 (SD: 22.46) vs 50.66 (SD: 19.49) minutes, p < 0.001). However, consultants had a higher mortality (1.6% vs 1.0%, p < 0.001) and incidence of postoperative dialysis (2.1% vs 1.5%, p < 0.001). Trainees performed 16.78% (8089/48220) multiple arterial graft procedures, with no differences compared with consultants for in‐hospital mortality (1.0% vs 0.9%, p = 0.42), cerebral vascular accident (transient ischaemic attack (0.5% vs 0.5%) and permanent stroke (0.6% vs 0.4%), p = 0.33), return to theatre (4.2% vs 4.47%, p = 0.089), postoperative renal dialysis (1.4% vs 1.1%, p = 0.076), and deep sternal wound infection (0.6% vs 0.6%, p = 0.87). Trainees performed 17.17% (8661/41778) off‐pump cases. Consultants had a higher in‐hospital mortality (1.2% vs 0.9%, p = 0.045) with no differences in cerebral vascular accident (transient ischaemic attack (0.2% vs 0.3%) and permanent stroke (0.4% vs 0.4%), p = 0.27), return to theatre (3.8% vs 3.9%, p = 0.69), postoperative renal dialysis (2.0% vs 1.6%, p = 0.059), and deep sternal wound infection (1.0% vs 0.8%, p = 0.66). Conclusion. Trainees in the United Kingdom have adequate exposure to advanced coronary surgery without compromising patients' safety. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES The popularity of off-pump coronary artery bypass grafting (CABG) varies across the world, ranging from 20% in Europe and the USA to 56% in Asia. We present the trend and early clinical outcomes in off pump in the UK. METHODS All patients who underwent elective or urgent isolated CABG from 1996 to 2019 were extracted from the National Adult Cardiac Surgery Audit database. The trend in operating surgeons and units volume and training in off pump were analysed. Early clinical outcomes between off- and on-pump CABG were compared using propensity score matching. RESULTS A total of 351 422 patients were included. The overall off-pump rate during the study period was 15.17%, it peaked in 2008 (19.8%), followed by a steady decreased to 2018 (7.63%). Its adoption varied across centres and surgeons, ranging from <1% to 48.36% and <1% to 85.5%, respectively, of total cases performed. After propensity score matching for the period 1996–2019, off pump, when compared to on pump, was associated with a lower in-hospital/30-day mortality (1.2% vs 1.5%, P  < 0.001), return to theatre (3.7% vs 4.5%, P  < 0.001), cerebrovascular accident (transient ischaemic attack: 0.3% vs 0.6%, stroke: 0.3% vs 0.6%, P  < 0.001) and deep sternal wound infection (0.8% vs 1.2%, P ≤ 0.001). In a sub-analysis from the introduction of EuroScore II (2012–2019), there were no differences in-hospital/30-day mortality (1.0% vs 1.0%, P  = 0.71). However, on pump, had a higher return to theatre (4.2% vs 2.7%, P  < 0.001), cerebrovascular accident (transient ischaemic attack: 0.4% vs 0.2%, stroke: 0.5% vs 0.3%, P  = 0.003) and deep sternal wound infection (1.0% vs 0.6%, P  = 0.004). CONCLUSIONS Our data show a decreasing trend in the use of off pump in the UK since 2008. This is likely to be multifactorial and raises the question of whether it should be a specialized revascularization technique. [ABSTRACT FROM AUTHOR]

Introduction: Coronary artery bypass grafting (CABG) remains a good revascularization strategy in octogenarians with excellent clinical outcomes and quality of life postoperatively. However, the benefits of off‐pump over on‐pump CABG in the elderly population are still controversial. We investigated this issue in the UK National Audit database. Method: We retrospectively analyzed all octogenarians undergoing nonemergency, isolated CABG from 1996 to 2019. Propensity score matching (PSM) was conducted to adjust for imbalance in the baseline characteristics between the off‐pump and on‐pump groups. Primary outcome was in‐hospital mortality and postoperative cerebrovascular accidents. Secondary outcomes were bleeding requiring reoperation, deep sternal wound infection, and postoperative dialysis. Result: A total of 6436 patients were included for analysis. No differences were observed between off‐ and on‐pump group in‐hospital mortality (4% vs. 3.8%, p =.89), return to theater rate (5.4% vs. 6.2%, p =.16) and incidence of deep sternal wound infection (1.1% vs. 1.6%, p =.34). However, octogenarian undergoing off‐pump CABG were less likely to experience postoperative transient ischemic attack (TIA)/stroke (1.4% vs. 2.3%, p =.004) but more likely to require renal dialysis (4.8% vs. 3.5%, p =.03). Conclusion: The data show similar in‐hospital mortality in octogenarians regardless of the revascularization technique used. Off‐pump when compared with on‐pump CABG is associated with a lower incidence in postoperative neurological events but a higher need for renal dialysis. [ABSTRACT FROM AUTHOR]